OBJECTIVES: Seven-valent pneumococcal conjugate vaccine (PCV7) has demonstrated dramatic public health impact and is considered highly cost-effective. Introduction of two new pneumococcal conjugate vaccines, 10-valent (PCV10) which is conjugated to protein-D, tetanus and diphtheria toxoids and 13-valent (PCV13) which is conjugated to CRM197 similar to PCV7, provides coverage to an additional 3 and 6 serotypes respectively, which is likely to result in further reduction in pneumococcal disease. We examined the incremental public health impact and cost-effectiveness of two new vaccines compared to PCV7 in Canada.
METHODS: A decision-analytic model (payer perspective) was developed to estimate impact of PCV13 and PCV10 vs. PCV7 on invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM). We used an epidemiological approach to track serotype specific incidence, disease sequelae, death, and costs, incidence, disease sequelae, indirect effects, utilities, and mortality data were obtained from surveillance systems in the province of Alberta, national vital statistics and published literature. Direct effects for PCV13 serotypes were assumed similar to those for PCV7 serotypes, whereas PCV10 was assumed to be less effective due to lower immunogenicity for the seven common serotypes. A 4-dose schedule and parity pricing were assumed.
RESULTS: When indirect effects due to herd immunity were considered for PCV7, PCV7 resulted in less costs and greater benefits than PCV10. In the absence of indirect effects, the ICER for PCV10 vs. PCV7 was $771,938 per QALY. PCV13 was cost saving compared to PCV7, whether indirect effects or direct effects alone were considered. Through direct effects, PCV13 pediatric vaccination would reduce 60% of IPD in vaccinated children.
CONCLUSIONS: PCV7 is estimated to be cost saving compared to PCV10. The broader serotype coverage of PCV13 would provide additional protection against pneumococcal disease and PCV13 is expected to be cost saving.
