OBJECTIVES: A 13-valent pneumococcal conjugate vaccine (PCV13), two 10-valent PCVs (PCV10-GSK, PCV10-SII), and 14-valent PCV (PCV14) are currently available for infant immunization in India private sector. This study aimed to compare health and economic impacts of different PCVs and cost-effectiveness of PCV13 versus alternative PCVs.

METHODS: A decision-analytic Markov model was adapted to compare health and economic impacts as well as cost effectiveness of PCV13 (3+1) versus PCV10-SII (3+0), PCV10-GSK (3+1), or PCV14 (3+0) from a payer perspective over a 10-year period. Pneumococcal disease incidence, serotype distribution, and utility inputs were derived from local data and recent published studies. Direct medical costs were sourced from local private hospital data. Direct vaccine effect (VE) estimates were based on clinical efficacy, effectiveness and immunogenicity studies across different PCVs. VE adjustment based on immunogenicity data was applied to PCV10-SII and PCV14. The model did not consider indirect VE. The prices per dose of PCV13, PCV10-GSK, PCV10-SII and PCV14 were ₹3,991, ₹2,599, ₹2,495 and ₹3,195, respectively. A 3% discounting per annum was applied to health and cost outcomes. This study assumed willingness-to-pay threshold (WTP) of 3 times the 2023 Indian GDP per capita (₹590,949).

RESULTS: Over 10 years, compared with PCV10-SII, PCV10-GSK, and PCV14, PCV13 was estimated to prevent additional 100,700, 75,200, and 137,300 more pneumococcal disease (PD) cases, and would result in corresponding cost savings due to PD prevention of ₹7.5, ₹5.6, and ₹9.2 million, respectively. Given the quality-adjusted life-years (QALY) gained and net cost estimates, the incremental cost effectiveness ratio (ICER) of PCV13 versus PCV10-SII, PCV10-GSK, and PCV14 were ₹221,009, ₹291,145, and ₹73,668 per QALY, which were below the WTP threshold.

CONCLUSIONS: From the private sector perspective, vaccinating children with PCV13 could prevent more PD cases, save more PD associated medical costs, and was more cost-effective compared to other alternative vaccination choices.