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