Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV′s) currently available in Mexico from a third payer perspective.
A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children 2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV′s. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY′s) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed.
Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY′s and 332.006 QALY′s and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV′s prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY′s, 282.969 and 114.972 QALY′s and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine.
In Mexico, immunization strategies based on 7, 10 and 13-valent PCV′s would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV′s.