Cost-Effectiveness of Switching From PCV13 to PCV20 in the Portuguese Childhood National Immunization Program

OBJECTIVES: The 13-valent pneumococcal conjugate vaccine (PCV13) was commercially available between 2010 and 2015 for private use and was included Portugal’s Childhood National Immunization Program (NIP) from July 2015. Despite the resulting decrease in pneumococcal disease (PD) incidence, a considerable disease burden persists, particularly from non-vaccine type serotypes. This cost‑effectiveness analysis evaluated the health and economic impact of implementing the PCV20 in Portugal’s pediatric population.

METHODS: A Markov multiple-cohort model with annual cycles over a 10-year time horizon was adapted to investigate the impact of PCV20 (3+1 schedule) versus the current standard of care (SoC) – PCV13 – and PCV15 (both in a 2+1 schedule) in Portugal. Benefits and costs were discounted at 4% from a Portugal National Health Service (NHS) perspective. Direct and indirect vaccine effects were based on PCV13 effectiveness and impact studies, and efficacy from PCV7 pivotal trials. Epidemiologic, utility, and cost inputs were obtained from published (Portugal-specific, where available) sources.

RESULTS: Compared with PCV13, PCV20 averted more cases of IPD (1,713), hospitalized pneumonia (49,145), otitis media (OM; 219,305), and deaths (7,812) in the base-case analysis. PCV20 provided greater health and economic benefits than PCV13, with 96,169 additional QALYs and total cost savings of €172,580,354, making PCV20 the dominant strategy. Similar results were observed with PCV20 versus PCV15 (1,505 IPD, 37,861 hospitalized pneumonia, and 198,630 OM cases, plus 5,895 deaths, averted). This resulted in higher QALY gain and lower cost (i.e., dominance) with PCV20 versus PCV15.

CONCLUSIONS: Over 10 years, PCV20 was estimated to prevent more disease cases and deaths, substantial direct cost offsets versus PCV13 and PCV15. The key model driver was PCV20’s broader serotype coverage. From the Portuguese NHS perspective, vaccination with PCV20 is a dominant alternative compared with the strategy currently in the NIP or PCV15, being an alternative economically favorable with yielding health benefits to the population.