Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

  • Edward Mezones-Holguín Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
  • Rafael Bolaños-Díaz Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
  • Víctor Fiestas Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
  • César Sanabria Faculty of Economics, Universidad Nacional Mayor de San Marcos, Lima, Peru
  • Alfonso Gutiérrez-Aguado Ministry of Economy and Finance, Government of Peru, Lima, Peru
  • Fabián Fiestas Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
  • Víctor J Suárez Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
  • Alfonso J. Rodriguez-Morales Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
  • Adrián V Hernández Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
Keywords: pneumonia, pneumococcal, pneumococcal vaccines, cost-effectiveness, immunization programs, Peru

Abstract

Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old.

Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated.

Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis).

Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

Author Biography

Alfonso J. Rodriguez-Morales, Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia

MD, MSc, DTM&H, FRSTM&H(Lon), FFTM RCPS(Glasg), PhD Candidate.

Advisor on Public Health, Epidemiology, Methodology and Biostatistics.

Researcher in Public Health and Tropical, Parasitic and Infectious Diseases.

Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.

Associated Researcher Ad Honorem, Instituto de Investigaciones José Witremundo Torrealba (former Trujillan Center for Parasitological Research), Universidad de Los Andes, Trujillo, Venezuela.
Published
2014-12-15
How to Cite
1.
Mezones-Holguín E, Bolaños-Díaz R, Fiestas V, Sanabria C, Gutiérrez-Aguado A, Fiestas F, Suárez VJ, Rodriguez-Morales AJ, Hernández AV (2014) Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children. J Infect Dev Ctries 8:1552-1562. doi: 10.3855/jidc.5855
Section
Original Articles