Elsevier

Vaccine

Volume 28, Issue 11, 8 March 2010, Pages 2302-2310
Vaccine

Cost-effectiveness of the CRM-based 7-valent pneumococcal conjugated vaccine (PCV7) in Argentina

https://doi.org/10.1016/j.vaccine.2009.12.070Get rights and content

Abstract

Due to the region's own conditions, universal vaccination with pneumococcal conjugate heptavalent vaccine (PCV-7) in Latin American countries is still controversial.

Objective

To compare projected economic costs and health benefits associated with pneumococcal conjugate heptavalent vaccine as a routine immunization in healthy children in Argentina.

Design

A decision analytic model of Markov simulated lifetime evolution of a birth cohort (n 696,451) was developed and compared costs and health benefits of pneumococcal disease in the presence and absence of vaccination.

Main outcome measures

Cost per life year (LY) gained, reduce in diseases burden and costs of vaccination.

Results

From the society's perspective, the incremental cost per LY gained was US$ 5599.42 and the purchase of the 4 doses of vaccine for the entire cohort with a cost of US$ 26.5 dose requires an investment of US$ 73,823,806.00.

The model estimated that vaccination reduce the number of death by 159 cases of meningitis, 756 cases of bacteriemias 4594 cases of pneumonias about 84,769 cases of otitis media and 20 meningitis sequelae.

The value of the cost per LY gained was considerably modified by the variation in the cost of the vaccine dose, efficacy/effectiveness of the vaccine for pneumonia the mortality from pneumonia and herd immunity.

Conclusions

Our analysis predicted that routine vaccination of healthy infants <2 years could prevent an important number of pneumococcal infectious and reduce related mortality and morbidity. This strategic could be highly cost-effective in Argentina.

Section snippets

Background

Streptococcus pneumoniae continues to be the most important causative agent of invasive bacterial infections in children and is the most common cause of vaccine-preventable deaths in children less than 5 years of age, globally, mainly from pneumonia.

PCV7 (Prevenar) contains 7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) each conjugated to the carrier protein, CRM197. These 7 serotypes cause the majority of invasive pneumococcal disease globally. PCV7 has been incorporated into the routine pediatric

Decision analysis model and health outcomes

A Markov analytical decision model [3], [4], [5], [6] was developed using a hypothetical annual birth cohort of 696,451, which constitutes the number of births during 2006 in Argentina [7] (Fig. 1) The model compared pneumococcal disease morbidity and survival for this population in the presence and absence of universal vaccination. Every newborn was initially deemed healthy and at risk of contracting a “primary event due to pneumococcal disease”. The following were considered as “primary

Health benefits cost and incremental analysis

Analysis demonstrates that annual vaccination of the birth cohort saves 159 lives over 5 years. During this timeframe 90,189 acute episodes of pneumococcal disease are prevented. Cases of pneumococcal disease prevented were as follows: 4594 pneumonias, 756 bacteremias; 70 meningitis (20 of which had neurologic sequelae) and 84,769 acute otitis media (Table 5).

According to regional serotype and vaccine efficacy data we can estimate that a PCV7 universal vaccination strategy in Argentina would

Discussion

Given the high morbidity and mortality of pneumococcal diseases among children <5 years of age, routine vaccination in Argentina with PCV7 has the potential to significantly reduce the burden of pneumococcal diseases. WHO guidelines states that a health strategy may be considered cost-effective when it does not exceed the 3 times the country's Gross Domestic Product per capita (GDP per capita) [48]. Considering the Argentine GDP per capita to be US$ 11,670 [49], the results of this study

Conclusions

  • The acquisition of the 4 doses of the vaccine for the whole cohort at a price of US$ 26.5 per dose required an investment of US$ 73,823.06.

  • Even the most conservative analysis, use of PCV 7 as part on Argentinean National Immunization Program will be a cost-effectiveness intervention with great impact over both sectors of health system (public and private).

  • In our sensitivity analysis the value of cost-effectiveness is robust for most of the assumptions and it is significantly modified by vaccine

Disclosure statement

The study was supported by Wyeth (currently Pfizer) through an unrestrictive educational grant. Dr. Alejandro Cané is an employee of Pfizer.

Acknowledgments

Agusti A. Antonia MD (Universidad Autonoma de Barcelona-Spain) for the Spanish manuscript review. Rodgers Gail MD (Senior Director Scientific Affair Wyeth (currently Pfizer)) for comments and English grammar review. Strutton David R. PhD (Director, Global Health Outcomes Assessment Wyeth (currently Pfizer)) for comments.

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