Cost-Effectiveness Analysis of the Pediatric 20-Valent Pneumococcal Conjugate Vaccine Compared to Lower-Valent Alternatives in Argentina

OBJECTIVES: In Argentina, the 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants in the national immunization programme (NIP) in a 2+1 schedule since 2012. Licensure of the 15- and 20-valent pneumococcal vaccines (PCV15 and PCV20) is expected in the near future. This cost-effectiveness analysis (CEA) examines switching from the current standard of care (PCV13) to either PCV15 or PCV20 in Argentina’s pediatric NIP.

METHODS: A decision-analytic Markov model with a yearly cycle length and 3.0% annual discount rate for costs and benefits enabled the CEA of PCV20 over a 10-year time horizon. Estimates of vaccine effectiveness were derived from PCV13 clinical effectiveness and PCV7 clinical efficacy studies. Population, epidemiologic, and economic inputs were obtained from published literature and Argentinian-specific sources. The study adopted a payer perspective with deterministic and probabilistic sensitivity analyses performed to evaluate the model robustness.

RESULTS: Compared with PCV13, PCV20 is estimated to have significant impact on disease burden by averting 11,291, 70,146, and 129,852 cases of invasive pneumococcal disease (IPD), all-cause pneumonia and otitis media (OM), respectively, as well as 6,718 deaths, resulting in savings of $123,018,764 in direct medical costs. Compared with PCV15, PCV20 is also estimated to have greater impact, avoiding 9,071, 56,474, and 106,538 cases of IPD, pneumonia, and OM as well as 5,169 deaths, resulting in savings of $100,341,893 in direct medical costs. As such, PCV20 is associated with a higher QALY gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. The findings were robust with little variance from the DSA and PSA as well as additional scenario assessments.

CONCLUSIONS: Over a 10-year time horizon, PCV20 is estimated to be the dominant, cost-saving strategy compared to PCV13 and PCV15. Policymakers should consider PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared to lower-valent options.