PCV20 FOR HIGH-RISK POPULATIONS: A COST-UTILITY ANALYSIS FROM THE BRAZILIAN PUBLIC HEALTH SYSTEM PERSPECTIVE
Author(s)
Mariana M. Sebastião, Bs, Paulo H. Almeida, Sr., Ph.D., Rodrigo Alexandre, MD,MBA;
Pfizer Inc., São Paulo, Brazil
Pfizer Inc., São Paulo, Brazil
Presentation Documents
OBJECTIVES: Pneumococcal diseases (PD), caused by Streptococcus pneumoniae, include invasive infections such as meningitis and bacteremia, and non-invasive forms like pneumonia. People with chronic conditions are at higher risk of developing PD. Current vaccination schemes recommended by the Brazilian National Immunization Program (NIP) involve multiple doses of pneumococcal conjugate and polysaccharide vaccines, which can lead to low vaccination coverage. The 20-valent pneumococcal conjugate vaccine (PCV20) may simplify immunization and improve protection. The object of this work was to evaluate the cost-utility of PCV20 compared to current vaccination schemes for people aged ≥5 years with risk conditions for PD in Brazil.
METHODS: A Markov model was constructed with a 10-year time horizon and annual cycles to simulate health outcomes and costs from the Brazilian NIP perspective. The hypothetical cohort received either one dose of PCV20, one dose of PCV13 plus two doses of PPSV23, or two doses of PPSV23. Health states included meningitis, bacteremia, hospitalized pneumococcal pneumonia, outpatient pneumonia, and death. Transition probabilities, vaccine effectiveness, and serotype coverage were derived from published evidence. Direct medical costs included vaccine acquisition and management of PD. Costs and QALYs were discounted at 5% annually. Results were expressed as incremental cost-effectiveness ratios (ICERs) per QALY considering the BRL 40,000/QALY gained threshold adopted by Brazil.
RESULTS: Compared to PCV13 + PPSV23, PCV20 yielded QALY gains (0.00042) and cost savings (-BRL 55.96), resulting in an ICER of -BRL 134,227.76/QALY. Compared to PPSV23 alone, PCV20 provided QALY gains (0.0018) with an incremental cost of BRL 10.02, yielding an ICER of BRL 5,665.44/QALY, i.e. cost-effective at the threshold employed in the country. In DSA and PSA, PCV20 remained dominant vs. PCV13 + PPSV23 and cost-effective vs. PPS23.
CONCLUSIONS: These results support the use of PCV20 as a simplified and cost-effective strategy for preventing PD in vulnerable people, supporting its inclusion into the NIP.
METHODS: A Markov model was constructed with a 10-year time horizon and annual cycles to simulate health outcomes and costs from the Brazilian NIP perspective. The hypothetical cohort received either one dose of PCV20, one dose of PCV13 plus two doses of PPSV23, or two doses of PPSV23. Health states included meningitis, bacteremia, hospitalized pneumococcal pneumonia, outpatient pneumonia, and death. Transition probabilities, vaccine effectiveness, and serotype coverage were derived from published evidence. Direct medical costs included vaccine acquisition and management of PD. Costs and QALYs were discounted at 5% annually. Results were expressed as incremental cost-effectiveness ratios (ICERs) per QALY considering the BRL 40,000/QALY gained threshold adopted by Brazil.
RESULTS: Compared to PCV13 + PPSV23, PCV20 yielded QALY gains (0.00042) and cost savings (-BRL 55.96), resulting in an ICER of -BRL 134,227.76/QALY. Compared to PPSV23 alone, PCV20 provided QALY gains (0.0018) with an incremental cost of BRL 10.02, yielding an ICER of BRL 5,665.44/QALY, i.e. cost-effective at the threshold employed in the country. In DSA and PSA, PCV20 remained dominant vs. PCV13 + PPSV23 and cost-effective vs. PPS23.
CONCLUSIONS: These results support the use of PCV20 as a simplified and cost-effective strategy for preventing PD in vulnerable people, supporting its inclusion into the NIP.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE194
Topic
Economic Evaluation
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Vaccines