Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Versus Lower-Valent Alternatives in Filipino Infants.

ABSTRACT

INTRODUCTION: The Philippines pediatric national immunization program (NIP) included the 13-valent pneumococcal conjugate vaccine manufactured by Pfizer (PCV13-PFE) since 2015. Uptake has been slow in particular regions, with coverage only reaching all regions in 2019. Given affordability challenges in the context of higher coverage, this study seeks to determine whether universal coverage across all regions of the Philippines with PCV13-PFE will provide good value for money compared with 10-valent PCV alternatives manufactured by GlaxoSmithKline (PCV10-GSK) or Serum Institute of India (PCV10-SII). METHODS: A decision analytic model is adapted for this cost-effectiveness analysis in the Philippines. Clinical and economic input parameters are taken from published sources. Future disease is predicted using age-stratified and population-level observed serotype dynamics. Total cases of pneumococcal disease, deaths, direct and indirect healthcare costs, and quality-adjusted life years (QALYs) gained are discounted 7% annually and modeled for each PCV. Given clinical uncertainty, PCV10-SII outcomes are reported as ranges. Incremental cost-effectiveness ratios (ICERs) are calculated for PCV13-PFE versus lower-valent PCVs (PCV10-GSK or PCV10-SII) from a societal perspective over 10 years. RESULTS: Nationwide PCV13-PFE use over 10 years is estimated to avert 375,831 more cases, save 53,189 additional lives, and gain 153,349 QALYs compared with PCV10-GSK. This equates to cost-savings of PHP 12.27 billion after vaccine costs are accounted for. Similarly, PCV13-PFE is more effective and cost-saving compared with PCV10-SII. Switching programs to PCV10-SII would result in more cases of disease (313,797 - 666,889), more deaths (22,759 - 72,435), and lost QALYs (108,061 - 266,108), equating to a net economic loss (PHP 359.82 million - 14.41 billion). PCV13-PFE remains cost-effective in the presence of parameter uncertainty. CONCLUSION: PCV13-PFE would prevent exceedingly more cases and deaths compared with lower-valent PCVs. Additionally, the PCV13-PFE program is estimated to continue providing cost-savings, offering the best value for money to achieve universal PCV coverage in the Philippines.