OBJECTIVES

To examine the benefits of pneumococcal conjugate vaccine (PCV) on controlling the development of antimicrobial resistance (AMR) in Ethiopia.

METHODS

We developed an agent-based model – DREAMR (Dynamic Representation of the Economics of AMR) – to assess the health impact and economic value of pneumococcal vaccination in curbing the accumulation of AMR. The model simulated children under age five with pneumococcal pneumonia, meningitis, or acute otitis media. The study incorporated PCV vaccination coverage, disease incidence, care-seeking behavior, and antibiotic utilization in pediatric patients. We modeled AMR development based on antibiotic exposure and fitness costs of Streptococcus pneumoniae using pharmacokinetics and pharmacodynamics. Resistance levels of penicillin, amoxicillin, and ceftriaxone in Ethiopia were studied, simulating the AMR impact of childhood immunization with PCV. We assessed the health and economic benefits in terms of direct and indirect medical costs, productivity losses for caretakers, and productivity losses due to premature deaths and disabilities.

RESULTS

Preliminary results suggested that the introduction of PCV vaccination has prevented the development of AMR against Streptococcus pneumoniae by 8% for amoxicillin, 2.1% for penicillin, and 1.1% for ceftriaxone in Ethiopia since 2011. In addition to the benefit of reduction in incidence of pneumococcal diseases, pneumococcal immunization averted approximately 103,800 antibiotic treatment failures and 1,530 deaths (31% reduction) due to AMR in Ethiopia between 2011 and 2017, resulting in savings of $30.1 million. Maintaining current PCV immunization coverage at 68% will contribute an additional $7.58 million in annual AMR cost savings over five years, which could increase to $9.84 million by increasing PCV coverage to 85% by 2022.

CONCLUSIONS

This is the first study we know of that estimates the AMR value of pneumococcal immunization. Immunization can save lives not only by reducing disease incidence but also by lessening antibiotic utilization and preventing AMR-related treatment failures.