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Economic evaluation of pneumococcal conjugate vaccination in The Gambia.

Kim SY, Lee G, Goldie SJ - BMC Infect. Dis. (2010)

Bottom Line: We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination.Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia.Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Policy and Management, Harvard School of Public Health, Center for Health Decision Science, Boston, MA, USA. sykim@hsph.harvard.edu

ABSTRACT

Background: Gambia is the second GAVI support-eligible country to introduce the 7-valent pneumococcal conjugate vaccine (PCV7), but a country-specific cost-effectiveness analysis of the vaccine is not available. Our objective was to assess the potential impact of PCVs of different valences in The Gambia.

Methods: We synthesized the best available epidemiological and cost data using a state-transition model to simulate the natural histories of various pneumococcal diseases. For the base-case, we estimated incremental cost (in 2005 US dollars) per disability-adjusted life year (DALY) averted under routine vaccination using PCV9 compared to no vaccination. We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination. To explore parameter uncertainty, we performed both deterministic and probabilistic sensitivity analyses. We also explored the impact of vaccine efficacy waning, herd immunity, and serotype replacement, as a part of the uncertainty analyses, by assuming alternative scenarios and extrapolating empirical results from different settings.

Results: Assuming 90% coverage, a program using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs, over the first 5 years of life of a birth cohort. Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia. The corresponding values for PCV7, PCV10, and PCV13 were $910, $670, and $570 per DALY averted, respectively. Sensitivity analyses that explored the implications of the uncertain key parameters showed that model outcomes were most sensitive to vaccine price per dose, discount rate, case-fatality rate of primary endpoint pneumonia, and vaccine efficacy against primary endpoint pneumonia.

Conclusions: Based on the information available now, infant PCV vaccination would be expected to reduce pneumococcal diseases caused by S. pneumoniae in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.

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Probabilistic sensitivity analysis: Cost-effectiveness acceptability curves. This graph summarizes the results of a probabilistic sensitivity analysis from the societal perspective. The curve shows, for each type of PCVs, the probabilities that pneumococcal vaccination would be cost-effective at varying cost-effectiveness threshold ratios. For example, the probabilities that PCV7 would be cost-effective are 8% and 66% at cost-effectiveness thresholds of $360 (corresponding to The Gambia's GDP per capita) and $1,080 (corresponding to three times The Gambia's GDP per capita) per DALY averted, respectively. All PCVs would be considered 100% cost-effective with the threshold set at $2,400 per DALY averted.
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Figure 5: Probabilistic sensitivity analysis: Cost-effectiveness acceptability curves. This graph summarizes the results of a probabilistic sensitivity analysis from the societal perspective. The curve shows, for each type of PCVs, the probabilities that pneumococcal vaccination would be cost-effective at varying cost-effectiveness threshold ratios. For example, the probabilities that PCV7 would be cost-effective are 8% and 66% at cost-effectiveness thresholds of $360 (corresponding to The Gambia's GDP per capita) and $1,080 (corresponding to three times The Gambia's GDP per capita) per DALY averted, respectively. All PCVs would be considered 100% cost-effective with the threshold set at $2,400 per DALY averted.

Mentions: Figure 5 presents the results of a probabilistic sensitivity analysis in the form of a cost-effectiveness acceptability curve for each pneumococcal vaccine. The curve for PCV9 shows that for the base-case the probabilities that the program would be cost-effective are 50%, 75%, and 100% at thresholds of $680, $890, and $1700 per DALY averted. At the threshold of $360, Gambia's GDP per capita, the probabilities that each of the programs would be very cost-effective are 8%, 13%, and 18% for PCV7, PCV10, and PCV13, respectively.


Economic evaluation of pneumococcal conjugate vaccination in The Gambia.

Kim SY, Lee G, Goldie SJ - BMC Infect. Dis. (2010)

Probabilistic sensitivity analysis: Cost-effectiveness acceptability curves. This graph summarizes the results of a probabilistic sensitivity analysis from the societal perspective. The curve shows, for each type of PCVs, the probabilities that pneumococcal vaccination would be cost-effective at varying cost-effectiveness threshold ratios. For example, the probabilities that PCV7 would be cost-effective are 8% and 66% at cost-effectiveness thresholds of $360 (corresponding to The Gambia's GDP per capita) and $1,080 (corresponding to three times The Gambia's GDP per capita) per DALY averted, respectively. All PCVs would be considered 100% cost-effective with the threshold set at $2,400 per DALY averted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944347&req=5

Figure 5: Probabilistic sensitivity analysis: Cost-effectiveness acceptability curves. This graph summarizes the results of a probabilistic sensitivity analysis from the societal perspective. The curve shows, for each type of PCVs, the probabilities that pneumococcal vaccination would be cost-effective at varying cost-effectiveness threshold ratios. For example, the probabilities that PCV7 would be cost-effective are 8% and 66% at cost-effectiveness thresholds of $360 (corresponding to The Gambia's GDP per capita) and $1,080 (corresponding to three times The Gambia's GDP per capita) per DALY averted, respectively. All PCVs would be considered 100% cost-effective with the threshold set at $2,400 per DALY averted.
Mentions: Figure 5 presents the results of a probabilistic sensitivity analysis in the form of a cost-effectiveness acceptability curve for each pneumococcal vaccine. The curve for PCV9 shows that for the base-case the probabilities that the program would be cost-effective are 50%, 75%, and 100% at thresholds of $680, $890, and $1700 per DALY averted. At the threshold of $360, Gambia's GDP per capita, the probabilities that each of the programs would be very cost-effective are 8%, 13%, and 18% for PCV7, PCV10, and PCV13, respectively.

Bottom Line: We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination.Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia.Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Policy and Management, Harvard School of Public Health, Center for Health Decision Science, Boston, MA, USA. sykim@hsph.harvard.edu

ABSTRACT

Background: Gambia is the second GAVI support-eligible country to introduce the 7-valent pneumococcal conjugate vaccine (PCV7), but a country-specific cost-effectiveness analysis of the vaccine is not available. Our objective was to assess the potential impact of PCVs of different valences in The Gambia.

Methods: We synthesized the best available epidemiological and cost data using a state-transition model to simulate the natural histories of various pneumococcal diseases. For the base-case, we estimated incremental cost (in 2005 US dollars) per disability-adjusted life year (DALY) averted under routine vaccination using PCV9 compared to no vaccination. We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination. To explore parameter uncertainty, we performed both deterministic and probabilistic sensitivity analyses. We also explored the impact of vaccine efficacy waning, herd immunity, and serotype replacement, as a part of the uncertainty analyses, by assuming alternative scenarios and extrapolating empirical results from different settings.

Results: Assuming 90% coverage, a program using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs, over the first 5 years of life of a birth cohort. Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia. The corresponding values for PCV7, PCV10, and PCV13 were $910, $670, and $570 per DALY averted, respectively. Sensitivity analyses that explored the implications of the uncertain key parameters showed that model outcomes were most sensitive to vaccine price per dose, discount rate, case-fatality rate of primary endpoint pneumonia, and vaccine efficacy against primary endpoint pneumonia.

Conclusions: Based on the information available now, infant PCV vaccination would be expected to reduce pneumococcal diseases caused by S. pneumoniae in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.

Show MeSH
Related in: MedlinePlus