RESEARCH – November 2012

Cost-effectiveness of pneumococcal vaccines in Estonia

Authors: Eva Juus, Marje Oona, Eda Tamm, Helena Järv, Kristi Liiv, Katrin Lutsar, Janek Saluse, Raul-Allan Kiivet

Articles PDF


Background. Streptococcus pneumoniae is a bacterial pathogen that is one of the leading causes of otitis media, pneumonia, meningitis and bacteremia. Morbidity of the diseases caused by Streptococcus pneumoniae can be prevented by vaccination.

Objective. To evaluate the cost-effectiveness of vaccination of newborns with 7-, 10- and 13-valent pneumococcal vaccines (PCV7, PCV10, PCV13) in Estonia compared with non-vaccination.

Methods. Using the Markov model an approximate annual birth cohort of 16, 000 was followed until the age of five. Vaccine coverage was assumed to be 95%. The effectiveness of PCV7 against out-patient otitis media and pneumonia was assumed to be 6%, against in-patient otitis media and pneumonia, 12% and 27%, respectively, and against invasive infections and associated deaths, 58%. Due to more serotypes included in PCV10 and PCV13, it was assumed that the effectiveness was accordingly 5% and 10% higher than for PCV7. Based on quality of life lost in association with outcomes, qualityadjusted life years (QALY) were calculated for vaccinated and non-vaccinated cohorts. Costs were considered from the perspective of third party payer and included treatment costs, prescription drugs, care benefits and vaccine costs. Costs and effects were discounted using an annual discount rate of 5%.

Results. Vaccination can avoid about 11-33% of otitis media and pneumonia and 65% of invasive infections. As compared with no vaccination, 35–37 QALYs would be gained during five years by vaccination of a birth cohort of 16,000. The incremental cost-effectiveness ratio ( ICER) would be 29, 000–62, 000 € per QALY gained. Vaccine price is the major impact factor for the estimate of cost-effectiveness.

Conclusion. Vaccination against pneumococcal infection would prevent a considerable number of otitis media, pneumonia and invasive infections. However, the costs of vaccination exceed the savings from the treatment costs more than tenfold.