Cost-Effectiveness Analysis of Pneumococcal Vaccination with the Pneumococcal Polysaccharide NTHi Protein D Conjugate Vaccine in the Philippines.
To compare the cost-effectiveness of a universal mass vaccination (UMV) program with a 2 + 1 schedule of a 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) against two strategies: 1) a no-vaccination strategy and 2) a pneumococcal 13-valent conjugate vaccine (PCV13) 2 + 1 strategy in the Philippines. A published Markov cohort model was adapted to simulate the epidemiological and economic burden of pneumococcal diseases (meningitis, bacteremia, pneumonia, and acute otitis media) within a projected birth cohort in 2012 of 1,812,137 newborns over lifetime. Analyses were conducted at an annual discount rate of 5% from the perspective of the Philippine government. The current evaluation was updated with the best available local/regional clinical epidemiological data and published efficacy evidence. Compared with the no-vaccination strategy, the PHiD-CV 2 + 1 UMV program was projected to prevent 3,343 deaths due to invasive pneumococcal diseases and pneumonia and 326,862 cases of pneumococcal diseases, resulting in an incremental cost-effectiveness ratio of 50,913 pesos/quality-adjusted life-year gained, which was considered to be highly cost-effective according to the threshold recommended by the World Health Organization. In comparison with the PCV13 2 + 1 strategy, the PHiD-CV 2 + 1 strategy was estimated to have a substantial reduction in acute otitis media (127,680 cases) and therefore a cost saving of potential 92.5 million pesos assuming price parity between PHiD-CV and PCV13 (US $1 = 42.13 pesos in 2012). The PHiD-CV 2 + 1 UMV program is projected to be cost-effective, compared with no vaccination, and would provide substantial savings with higher quality-adjusted life-year gains as compared with the PCV13 2 + 1 strategy in the context of the Philippines.