RESEARCH – November 2017

The cost-effectiveness of pneumococcal conjugate vaccination in a cohort of infants in Estonia

Authors: Indrek Saar, Inga Posiuniene, Jan Olbrecht, Benedetto Simone, Oscar Leeuwenkamp, Nicolas Van de Velde

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Background and goals. Estonia is now considering adding a pneumococcal conjugate vaccine (PCV) in its national immunization program to help reduce the burden of invasive pneumococcal diseases (IPD), pneumonia and acute otitis media (AOM). In this cost-effectiveness analysis (CEA), we estimate the vaccine price under which vaccinating with the pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) is considered cost-effective compared to no vaccination.

Methods. A static Markov cohort model was adapted for Estonia using local serotype distribution, disease incidence and direct costs. The model’s parameters were defined using Estonian data when available. However, for some parameters local data was not available and literature data was employed to fill in gaps. The assumptions regarding vaccine`s efficacy originate from large PCV randomized controlled trials. The base-case parameters were validated by an expert panel and alternative scenarios were explored. The cohort was vaccinated at 2, 4 and 12 months with 95% coverage and followed over lifetime (annual discount 5%, healthcare provider`s perspective).

Results. Under the base-case assumptions, vaccinating a cohort of 13,555 infants in Estonia with PHiD-CV would prevent 3,801 AOM-related outpatient visits, 240 tympanostomy tube placements, 92 cases of pneumonia, 85 cases of IPD and 14 deaths over the cohort’s lifetime. The results of overall effectiveness translate into 290 undiscounted quality-adjusted life years (QALYs) gained (43 QALYs discounted) and €325,043 saved in total undiscounted direct costs (€125,353 discounted). With an Estonian Gross Domestic Product (GDP) per capita of €15,301 (2014) and accounting for discounted direct costs only, the programme would then be considered highly cost-effective (incremental cost-effectiveness ratio (ICER) < 1 GDP/capita) if the vaccine price is below €24.19/dose (€45.12 and €66.05/dose for 2x and 3x GDP/capita, respectively). Alternative scenarios in which net herd protection is half that of the basecase, discounting is at 3% and productivity loss is accounted for, would result in highly cost-effective thresholds of €20.22, €39.43 and €24.49/dose, respectively.

Conclusions. Our model predicts that PCV vaccination would be highly cost-effective under €24.19/dose and would remain costeffective up to €66.05/dose in Estonia.