Cost-effectiveness of pneumococcal conjugate vaccines of 7, 10, and 13 valences in Colombian children

BackgroundCurrently there are three pneumococcal conjugate vaccines with different coverage of serotypes for use in children under one year. We evaluate the cost-effectiveness of the introduction of pneumococcal conjugate vaccines of 7, 10, and 13 valences in the Colombian EPI.MethodsA Markov model, which followed a cohort of children under one year to life expectancy, was developed. Parameters of occurrence and care costs were based on data from National Health System and literature review. PCV-7 is a dominated strategy. PCV-10 and PCV-13 were each compared to no vaccination or PCV-10 vaccination, respectively. A 2 + 1 schedule and a vaccination price of US$ 14.00, US$ 14.85 and US$ 16.34 per dose were assumed in the base case for PCV-7, -10, and PCV-13 vaccines.ResultsIntroduction of PCV-13 rather than PCV-10 increases the number of life years gained (LYG). From the societal perspective, in the ‘competing choice’ framework cost per LYG was US$ 1837 with PCV-10 and US$ 9514 with PCV-13, while PCV-7 is a dominated strategy. The ICER of PCV-13 is above the per capita Gross Domestic Product. Incremental cost-effectiveness ratios (ICERs) were influenced mainly by effectiveness against radiologically-confirmed pneumonia and AOM, vaccine price, and discount rate.ConclusionRoutine vaccination against Streptococcus pneumoniae in Colombia would be cost-effective with PCV-10, with ICER below the per-capita GDP, but its inclusion requires evaluating the budget impact. PCV-13 would prevent more disease and deaths with a higher LYG, but PCV-10 would save more cost to the healthcare system due its higher impact in the prevention of AOM. There is limitation in the clinical evidence of both strategies.

► We model PCV-7, -10, and -13 vaccination in under one year old Colombian population.
► We examine cost per YLG with each alternative and in different comparisons.
► Vaccination with PCV-10 is cost-effective from the societal perspective.
► Vaccination with PCV-13 is above the 1 per-capita GDP.
► Effectiveness data of PCV-10 and PCV-13 are required to validate our results.