OBJECTIVES: Streptococcus pneumoniae (pneumococcus) can cause invasive pneumococcal diseases (IPD) such as meningitis and non-invasive disease, including pneumonia and acute otitis media (AOM). Since 2009, the paediatric immunization program in Sweden included the pneumococcal conjugate vaccine (PCV13) and the pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D-conjugate vaccine (PHiD-CV), leading to an overall decrease in pneumococcus-related disease and AOM. The aim of this study is to assess the cost-effectiveness of PHiD-CV compared to PCV-13 in children from a societal perspective in Sweden.

METHODS: A previously developed Markov model from 2013 that simulates the disease course of IPD, pneumonia and AOM within a cohort of 114,663 newborns was adapted to reflect 2022 Swedish costs and recent epidemiology data. In total, the model comprised eleven distinct health states (nine invasive or non-invasive disease health states, one health state for no disease and one absorbing death state). Outcomes of interest were number of disease cases, costs, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio. Costs and outcomes were discounted both at 3%. A Poisson regression was used to adapt the vaccine efficacy against hospitalized pneumonia with real-world data from 2007 and 2019.

RESULTS: Compared to PCV13, the model predicted that PHiD-CV would prevent an additional 168 hospitalized pneumonia cases. However, no difference was found in ambulant pneumonia cases. Moreover, 3 AOM myringotomies and 13,787 ambulant AOM cases could be additionally avoided with PHiD-CV throughout an entire lifetime. There were 3 more IPD cases (2 extra bacteremia cases and 1 extra meningitis case) estimated with PHiD-CV. Overall, PHiD-CV led to an estimated cost-saving of 54M kr and it was the most effective with 80 QALYs gained.

CONCLUSIONS: This cost-effectiveness analysis showed that PHiD-CV is dominant over PCV-13 in a Swedish paediatric cohort eligible for a 3-dose schedule with a pneumococcal conjugate vaccine.