Cost-Effectiveness Analysis of the 13-Valent Pneumococcal Conjugate Vaccine Compared With Higher-Valent Alternatives in the Pediatric Population of Paraguay
Author(s)
Thea Paoula Nassar, MSc1, Carolina Carballo, MD2, Monica Rodriguez, MD3, Liping Huang, MSc, MD4, Lucila Rey Ares, MSc, MD2.
1Pfizer Ltd., England, United Kingdom, 2Pfizer Inc., Villa Adelina, Argentina, 3Central Hospital, Social Security Institute, Asunción, Paraguay, 4Pfizer Inc., Washington Crossing, PA, USA.
1Pfizer Ltd., England, United Kingdom, 2Pfizer Inc., Villa Adelina, Argentina, 3Central Hospital, Social Security Institute, Asunción, Paraguay, 4Pfizer Inc., Washington Crossing, PA, USA.
OBJECTIVES: A 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to Paraguay’s pediatric national immunization program (NIP) in 2017. With the newly approved higher-valent PCVs (15-valent PCV [PCV15] and 20-valent PCV [PCV20]), this study examined the cost-effectiveness of vaccinating children with PCV20 and PCV15 versus the current standard of care (PCV13).
METHODS: A decision-analytic Markov model was adapted to compare PCV20 vs. PCV13 and PCV15 vs. PCV13, all under a 2+1 schedule, over 10 years. In each annual cycle, both vaccinated (children <2 years) and unvaccinated individuals could transition to a pneumococcal disease (PD) state (i.e. invasive pneumococcal disease [IPD], hospitalized and non-hospitalized pneumonia, and acute otitis media [AOM]) or remain in a non-disease state. Cost and health outcomes were discounted at 3% annually from a payer perspective. Direct and indirect VE was derived from PCV7 and PCV13 clinical efficacy, effectiveness, and impact studies. Population, epidemiologic, serotype coverage and cost inputs were obtained from Paraguay-specific official sources and relevant literature. Costs were reported in 2025 $USD.
RESULTS: Over the 10-year time horizon, PCV20 was projected to avert 101 IPD cases, 40,501 non-invasive pneumococcal disease (PD) cases, and 831 deaths compared to PCV13. Whereas, PCV15 compared to PCV13 was estimated to prevent 22 IPD cases, 7,194 non-invasive PD cases, and 264 deaths. Additionally, PCV20 vs. PCV13 was estimated to result in greater clinical outcomes compared to PCV15 vs. PCV13 (i.e. averting 80 additional IPD cases, 33,307 additional non-invasive PD cases and 567 additional deaths). Consequently, PCV20 was estimated to save the healthcare system $44.2 million versus PCV13.
CONCLUSIONS: PCV20 offers broader serotype coverage and was estimated to avert more PD cases and deaths than PCV13 and PCV15. Replacing lower-valent PCVs with PCV20 in the NIP was the most cost-saving and effective (dominant) option in Paraguay.
METHODS: A decision-analytic Markov model was adapted to compare PCV20 vs. PCV13 and PCV15 vs. PCV13, all under a 2+1 schedule, over 10 years. In each annual cycle, both vaccinated (children <2 years) and unvaccinated individuals could transition to a pneumococcal disease (PD) state (i.e. invasive pneumococcal disease [IPD], hospitalized and non-hospitalized pneumonia, and acute otitis media [AOM]) or remain in a non-disease state. Cost and health outcomes were discounted at 3% annually from a payer perspective. Direct and indirect VE was derived from PCV7 and PCV13 clinical efficacy, effectiveness, and impact studies. Population, epidemiologic, serotype coverage and cost inputs were obtained from Paraguay-specific official sources and relevant literature. Costs were reported in 2025 $USD.
RESULTS: Over the 10-year time horizon, PCV20 was projected to avert 101 IPD cases, 40,501 non-invasive pneumococcal disease (PD) cases, and 831 deaths compared to PCV13. Whereas, PCV15 compared to PCV13 was estimated to prevent 22 IPD cases, 7,194 non-invasive PD cases, and 264 deaths. Additionally, PCV20 vs. PCV13 was estimated to result in greater clinical outcomes compared to PCV15 vs. PCV13 (i.e. averting 80 additional IPD cases, 33,307 additional non-invasive PD cases and 567 additional deaths). Consequently, PCV20 was estimated to save the healthcare system $44.2 million versus PCV13.
CONCLUSIONS: PCV20 offers broader serotype coverage and was estimated to avert more PD cases and deaths than PCV13 and PCV15. Replacing lower-valent PCVs with PCV20 in the NIP was the most cost-saving and effective (dominant) option in Paraguay.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH53
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Public Health
Disease
Pediatrics, Vaccines