Economic evaluation of universal 7-valent pneumococcal conjugate vaccination in Taiwan: a cost-effectiveness analysis.

BACKGROUND/PURPOSE: Pneumococcal diseases caused by Streptococcus pneumoniae can lead to significant morbidity and mortality in young infants and the elderly. The seven-valent pneumococcal conjugate vaccine (PCV7) has been available on the private market in Taiwan since October 2005. To date, there has not been any cost-effectiveness analysis (CEA) of PCV7 in Taiwan. A pharmacoeconomic model populated with local parameters is needed for vaccine decision-making. The aim of the study was to provide a CEA of PCV7 in Taiwan and explore the impact of herd effect and indirect cost on the findings of CEA. METHODS: A decision analytic model was populated with local epidemiological and economic data to simulate the expected clinical and economic outcomes from a hypothetical vaccinated birth cohort of 191,310 infants compared to no vaccination over a 10-year time horizon. To explore the impact of herd effect, results were presented with and without herd effect. Moreover, the study was conducted from both payer and societal perspectives to examine the impact of indirect cost. One-way sensitivity analyses were performed to evaluate model robustness. The cost-effectiveness of a reduced three-dose schedule was also estimated. RESULTS: PCV7 vaccination could prevent 1281 cases of invasive pneumococcal diseases, 178,145 cases of all-cause hospitalized pneumonia, 69,962 cases of all-cause acute otitis media, and 981 deaths over a 10-year time horizon. The vaccination program with an annual cost of NT$1,950.5 million could lead to 15.4% reduction in direct medical costs of NT$6,010 million and 64.1% reduction in indirect costs of NT$9,467 million. The vaccination with a four-dose schedule would lead to an incremental cost of NT$1,183,028 per life-year gained from the payer perspective and NT$619,862 per life-year gained from the societal perspective. CONCLUSION: Taking herd effect and indirect costs into account, PCV7 vaccination is cost-effective in Taiwan. Further pharmacoeconomic model should include herd effect in CEA of infectious disease research.

Cost-effectiveness analysis of pneumococcal conjugate vaccine in Taiwan: a transmission dynamic modeling approach.

OBJECTIVES: Streptococcus pneumoniae causes significant morbidity and mortality worldwide. Static pharmacoeconomic models have been used to conduct pharmacoeconomic analyses of pediatric pneumococcal conjugate vaccination programs. The objective of this study was to develop a transmission dynamic model to evaluate the cost-effectiveness of a 13-valent pneumococcal conjugate vaccine (PCV13) in Taiwan. METHODS: An age-structured transmission dynamic model was populated with parameters from the Taiwanese National Health Insurance Research Database and publicly available sources to evaluate the clinical and economic impact of PCV13. Sensitivity analyses were performed to explore model uncertainties. RESULTS: In the base-case analysis, four-dose scheduled universal infant PCV13 vaccination will prevent 5112 cases of invasive pneumococcal diseases, 535,607 cases of all-cause hospitalized pneumonia, 726,986 cases of acute otitis media, and 420 deaths over a 10-year time horizon since 2009. The four-dose vaccination program is estimated to yield an incremental cost-effectiveness ratio of US$38,045 and US$18,299 from payer and societal perspectives. One-way sensitivity analyses indicated that the incremental cost-effectiveness ratio is most sensitive to vaccine price. The 95% confidence interval of the incremental cost-effectiveness ratio was US$10,186 to US$34,563 by multivariate probabilistic sensitivity analyses in the societal perspective. CONCLUSIONS: With a World Health Organization-recommended cost-effectiveness threshold, the PCV13 vaccination program would be cost-effective in Taiwan. To circumvent the lack of long-term real data, a transmission dynamic model is informative to decision makers on evaluating the long-term cost-effectiveness of PCV13.