OBJECTIVES: A cost-effectiveness analysis of routine infant vaccination with pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) or 13-valent pneumococcal conjugate vaccine (PCV-13) in 47 countries supported by Gavi the Vaccine Alliance was performed.

METHODS: We developed a static decision tree model to predict disease burden in a cohort (2017; n=73,444,814) up to the age of 5 years. Pneumonia, invasive pneumococcal disease and acute otitis media (AOM) were considered. We estimated the number of cases, direct medical costs from the healthcare system perspective and disability-adjusted life-years (DALYs) accrued in an unvaccinated cohort and the same outcomes associated with each vaccine. Incremental cost-effectiveness ratios (ICER) for each vaccine versus no vaccination were generated. Incidences and costs were based on published regional or country-specific estimates. Same efficacies were applied for both vaccines across diseases except against AOM. Costs (in 2015 USD) and effects included 3% discount. Uncertainty is captured by a Monte Carlo analysis using confidence intervals on efficacies and disease incidences.

RESULTS: Immunisation with either vaccine is predicted to prevent over 2 million (M) hospitalisations and 190,000 deaths. PHiD-CV would prevent an additional 27M AOM cases and more AOM complications than PCV-13. Vaccination program costs are estimated to be USD773.5M and USD754.0M overall, and are offset by substantial savings of USD357.9M and USD296.1M for PHID-CV and PCV-13 respectively. ICER was more favourable for PHiD-CV in 44 of the 47 countries (range: USD3-209/DALYs averted) compared with PCV-13 (range: USD25-208/DALYs averted). PHiD-CV had a more favourable ICER than PCV-13 in 48.3% to 94.1% of Monte Carlo simulations across countries.

CONCLUSIONS: Vaccinations with PHiD-CV or with PCV-13 are both cost-effective strategies in all 47 countries. PHiD-CV is cost-saving in all countries and provides greater health benefits in 44 countries compared with PCV-13, due to greater reductions in AOM and related complications.

FUNDING: GlaxoSmithKline Biologicals S.A. (HO-16-17039).