OBJECTIVES

Pneumococcal diseases caused by Streptococcus pneumoniae pose a significant health and economic burden. Australia introduced the 7-valent pneumococcal conjugate vaccine (7vPCV) on the universal infant National Immunisation Program (NIP) in 2005 and replaced it with the 13-valent (13vPCV) in 2011. The objective was to quantify the clinical and economic impact of the universal infant PCV program in Australia.

METHODS

A decision-analytic model was adapted to estimate the historical impact of PCVs in Australia. Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) for age strata were obtained from Australian epidemiologic databases, supplemented with published data. Hospitalization and procedure data were from Australian Institute of Health and Welfare. General Practitioner encounters for pneumonia and AOM were from Bettering the Evaluation and Care of Health (BEACH) dataset. Costs were from Medicare Benefits Schedule in 2018 Australian dollars. Historical observed changes in disease for the universal PCV NIP era (2005- 2017) were compared against a “no-vaccine” scenario. The expected incidence for no-vaccine scenario in years 2005-2017 was calculated using pre-universal PCV NIP era (2001-2004) data. Averted cases, deaths, incremental costs and quality-adjusted life years (QALYs) were obtained by subtracting the vaccine scenario totals from the no-vaccine scenario totals.

RESULTS

From the inclusion in the universal infant NIP, 7vPCV and 13vPCV are estimated to have prevented 1,770,024 cases of pneumococcal disease (IPD=16,392; AOM=1,575,491; pneumonia=102,059) and 1,195 associated deaths. Over this period, there was a total 24,335 QALYs gained. Costs for the universal infant NIP were offset by $733 million direct costs saved, resulting in an incremental cost-effectiveness ratio of $3,347 per QALY gained.

CONCLUSIONS

This analysis showed the substantial public health and economic value that 7vPCV and 13vPCV have provided from sustained use in Australia. Maintaining 13vPCV on the Australian infant NIP will likely provide continued return-on-investment and sustained reductions in pneumococcal disease.