Document text
1E conomic A ssessment of R outine PC V 20 for C hildren
C harles Stoecker
Tulane University
School of Public Health and Tropical Medicine
ACIP
June 22, 2023
2Conflicts of Interest
Dr. Stoecker has no conflicts of interest to declare.
3Acronyms
PC V : pneumococcal conjugate vaccine
PCV 13: 13 valent PCV
PCV 15: 15 valent PCV
PCV 20: 20 valent PCV
PPSV 23: 23 valent pneumococcal polysaccharide vaccine
V E : vaccine effectiveness
V T: vaccine type
ST: s e r o t yp e
AOM: acute otitis media
NBP : n o n -bacteremic pneumonia
IPD: invasive p neumococcal disease
IPT: inp atient
OPT : outpatient
QAL Y : quality adjusted life year
I C : immunocompromised
CMC: chronic medical conditions, b ut not IC
C PI : C onsumer price index
NIS: National Immunization Survey
ABCs: Active Bacterial Core Surveillance System
4Policy Question 1
Should PCV20 be recommended as an option for
pneumococcal conjugate vaccination according to currently
recommended dosing and schedules, for U.S. children aged
<2 years?
Evaluate the disease and cost impacts of using PCV20 in
place of existing conjugate vaccines in six interventions:
Intervention Comparator Population
P CV2 0 P CV1 3 Healthy
PCV 20+PPSV PCV 13+PPSV CMC
PCV 20+PPSV +PPSV PCV 13+PPSV +PPSV IC
P CV2 0 P CV1 5 Healthy
PCV 20+PPSV PCV 15+PPSV CMC
PCV 20+PPSV +PPSV PCV 15+PPSV +PPSV IC
C onjugate doses are given in a 3+1 schedule (3 doses at age 0, 1 dose at age 1),
PPSV doses are given at age 2 for CMC & I C and at age 7 for I C
5Policy Question 2
Should PCV20 without PPSV23 be recommended as an
option for pneumococcal vaccination for U.S. children aged
2–18 years with underlying medical conditions that
increase the risk of pneumococcal disease?
Evaluate the disease and cost impacts of using PCV20 in
place of existing schedules that include conjugate and
polysaccharide in six interventions:
Intervention Comparator Population
P CV2 0 PCV 13+PPSV CMC
P CV2 0 PCV 13+PPSV +PPSV IC
P CV2 0 PCV 15+PPSV CMC
P CV2 0 PCV 15+PPSV +PPSV IC
PCV 20+PPSV P CV2 0 CMC
PCV 20+PPSV +PPSV P CV2 0 IC
C onjugate doses are given in a 3+1 schedule (3 doses at age 0, 1 dose at age 1),
PPSV doses are given at age 2 for CMC & I C and at age 7 for I C
6Methods
Cohort model
United States birth cohort 3,939,295
•91.1% healthy a
•8.8% CMC a
•0.1% IC a
•Background mortality rates from National Center for Health Statistics
Vital Statistics
Societal p ersp ective
•Medical & nonmedical (work loss) costs
A ll future outcomes (health & cost) discounted at 3%
Costs inflated to 2022$ by CPI or CPI Medical Care
Disease incidence followed for 15 years after final PCV20 shot
•Direct & indirect protection followed over this cohort
•QA L Y losses from death and permanent disease states aggregated over the lifetime
a Pelton 2014. T ables 1 & 2.
7Outcomes
IPD cases (meningitis & other)
Meningitis sequelae (deafness & other disability)
Non-invasive pneumonia (inpatient & outpatient)
Otitis media & tympanostomy tube placement
Deaths
QALYs & life years
Costs
Cost/QALY
8Complete Series PCV Vaccine Effectiveness
VE Reference
VT IPD (e xce p t ST3, ST19F) 86 (76, 92) Moore 2016
ST3 IPD 26 (0, 68) Andrews 2014
ST19F IPD 75 (37, 90) Andrews 2014
VT NBP (except ST3, ST19F) 51.6 (45.6, 55.2) b
ST3 NBP 15.6 (0, 40.8) b
ST19F NBP 45 (22.2, 54) b
VT AOM (except ST3, ST19F) 54 (41, 64) Eskola 2001
ST3 AOM 16.3 (12.4, 19.3) c
ST19F AOM 47.1 (35.8, 55.8) d
Note: T he displayed V E values apply only after receipt of 4th dose. V E during the 1st year (age 0 -1) is 75.7% of these numbers.
(A dapted from Whitney et al. 2006)
b A pplied ratio of V E for NB P to V E for I PD for adults from C A PI T A study to pediatric V E s vs I PD above
c Ap p lied ratio of p ediatric ST3 IPD to other VT IPD ab ove to Esko la estimate for V T A OM
d Ap p lied ratio of p ediatric ST19F IPD to other VT IPD ab ove to Esko la estimate for V T A OM
9PPSV Vaccine Effectiveness
VE Source
VT IP D 59.7 (47.4, 69.1)Falkenhorst 2017 &
Thorrington 2018
VT NBP 20 (0, 40) ACIP WG Discussion
VT AOM 0 ACIP WG Discussion
10Indirect Effects
Effects on other children
A pply to unvaccinated children and children whose vaccination protection is not
100% (i.e., all children)
A pply to PC V 20 unique types only
R emove 7.8% of disease each year
Effects on adults
For childhood cohort model, modeled effects on all U.S. adults (258 million)
U sed inputs from our model previously used to analyze PC V 20 effects on adults
Modeled 1 year of impacts on adults for this childhood cohort
•2nd year of impacts on adults would be influenced by 2nd childhood cohort, etc.
U sed output from previously used C DC Win BUGS model that shows each childhood
cohort responsible for 4.12% decline in previous year’ s disease on average
•W e modified this 4.17% to account for an anticipated 15 years of use to arrive at an average of 3.12%
disease reduction per childhood cohort
I ndirect effects from adults (QA L Y s and cost savings) were then apportioned to
each risk status of children according to their contribution to total QA L Y s saved.
•If vaccinating healthy children was resp onsib le for 50% of total QAL Ys saved among
children, then 50% of cost and QA L Y savings from adults were allocated to the healthy
group.
11Other Vaccine Assumptions
Coverage
3-dose PC V series (completed by 13 months, applied to 1st year)
•94.2% (93.6, 94.8) Hill MMWR 2023
4-dose PC V series
•81.9% (80.9, 82.2) Hill MMWR 2023
1st d o se PPSV (CMC & IC)
•78.1%
2nd d ose PPSV (IC)
•64.0%
Waning
P C V: Ye a r s 0 -5 get full VE
•Waning linearly to 0% over next 10 years
PPSV : Wane linearly to 50% in first 5 years
•W ane linearly to 30% in next 5
•W ane to 0% in last 5 years
Adverse events
A ll vaccines were assumed to have no adverse events
12AOM Incidence
Ag e 0 1 2 3 4
All cause AOM visits,
healthy (p er 1k) a507
(358,701 )507
(358,701 )319
(229,435)319
(229,435)319
(229,435)
All cause AOM visits,
CMC/ IC (p e r 1k) b1533
(1083,2117)1533
(1083,2117)686
(491,936)686
(491,936)686
(491,936)
% of A OM with tympanostomy
tube insertion c12% (6- 15) 12% (6- 15) 8% (4 -15)8% (4 -15)8% (4 -15)
% pneumococcal A OM d 14.0% 14.0% 16.0% 16.0% 16.0%
Note: No A OM incidence assumed for ages 5+.a overall numb ers from National Amb ulatory Medical Survey/National Hosp ital Amb ulatory Medical Care Survey+Market Scan data
2016+2018,b Market Scan Data 2016 -2018
c Pichichero et al. 2013
d K aur et al. 2022
13NBP Incidence
Age 0 1 2 3 4 5 6 7 8 9+
OPT NB P , healthy (per
100k) a640
(594,686)1291
(1192,1386)1512
(1368,1658)785
(715,859)639
(583,693)678
(618,733)575
(524,622)711
(626,800)357
(323,391)319
(294,345)
OPT NBP, CMC/ IC (p e r 100k)
b9249
(56388,
65090)18656
(113162,
131601)14881
(74090,
89811)7728
(38714,
46492)6294
(31556,
37506)5060
(21862,
25905)4296
(18546,
21986)5308
(22121,
28290)2664
(11413,
13815)2384
(10384,
12189)
% pneumococcal c 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10) 6% (1 -10)
I PT NB P , healthy (per 100k)
d588
(546,630)417
(385,448)390
(353,427)202
(184,221)165
(150,179)121
(111,131) 103 (94,112)127
(112,143) 64 (58,70) 57 (52,61)
IPT NBP, CMC (p e r 100k)
e
1642
(1524,1759)1164
(1075,1250)1087
(984,1193)564
(514,617)461
(420,499)544
(496,588)462
(422,500)568
(500,639)286
(258,313)255
(235,275)
IPT NB P , IC (per 100k)
e
3283
(3048,3518)2328
(2150,2501)2174
(1968,2386)1128
(1027,1234)922
(840,998)1328
(1212,1436)1129
(1029,1220)1386
(1220,1560)697
(631,764)623
(573,672)
% IPT NPB fatality d
1.3% (1.02 -
1.59)0.53%
(0.37- 0.70)0.40%
(0.23- 0.58)0.42%
(0.21- 0.64)0.61%
(0.32- 0.91)0.39%
(0.15- 0.63)0.32%
(0.06- 0.59)0.78%
(0.35- 1.20)0.51%
(0.13- 0.89)1.72%
(1.42- 2.01)
% pneumococcal c 12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)12% (2- 20)
a overall mean from Tong et al. 2018, 5th & 9 5th p ercentiles calculated using the ratio of 5th & 9 5th to mean in I PT NB P for each age; adjusted by (1 -% CMC+IC p o p * CMC+IC
ratio)/% healthy pop; C MC +I C ratio from MarketScan 2016 -2018
b based on Tong et al. 2018, but scaled by age -sp ecific ratios of CMC+IC to healthy calculated from MarketScan 2016 -2018
c A dapted from Jain et al. 2015 with expert input.d Overall numbers from 2018 -2019 NIS Data, scaled by (1 -(% IC p o p * IC ratio + % CMC p o p * CMC ratio )) / % h e alth y p o p , ratio s f o r IC an d CMC fro m Pe lto n e t al. 2014
e Overall numbers from 2018 -2019 NI S Data, scaled by rate ratios for health: CMC:I C from Pelton et al. 2014
14IPD Incidence
Ag e 0 1 2 3 4 5 6 7 8 9+
IPD In cid e n ce ,
healthy (per 100k)
a14 (11, 16) 10 (7, 12) 5 (3, 6) 5 (3, 6) 3 (2, 4) 5 (3, 6) 3 (1, 4) 2 (1, 3) 1 (0, 2) 1 (1, 1)
IPD In cid e n ce , CMC (p e r 100k)
a24 (20,29) 18 (13,22) 8 (5,11) 9 (5,11) 6 (4,7) 15 (10,20) 9 (3,13) 7 (3,10) 5 (0,7) 3 (3,3)
IPD In cid e n ce , IC (per 100k)
a152
(123,179)112
(78,134)51
(34,67)54
(34,67)34
(22,45)182
(120,241)112
(40,160)81
(40,120)56
(0,80)40
(40,40)
% meningitis a15.87
(14.45,17.43)15.87
(14.45,17.43)15.87
(14.45,17.43)15.87
(14.45,17.43)15.87
(14.45,17.43)20.05
(18,22.33)20.05
(18,22.33)20.05
(18,22.33)20.05
(18,22.33)20.05
(18,22.33)
% meningitis resulting in fatality
a10.48
(7.85,13.99)10.48
(7.85,13.99)10.48
(7.85,13.99)10.48
(7.85,13.99)10.48
(7.85,13.99)0.00% 0.00% 0.00% 0.00% 0.00%
% o t h e r IPD resulting in fatality
a3.61
(2.92,4.47)3.61
(2.92,4.47)3.61
(2.92,4.47)3.61
(2.92,4.47)3.61
(2.92,4.47)3.83
(2.93,5.02)3.83
(2.93,5.02)3.83
(2.93,5.02)3.83
(2.93,5.02)3.83
(2.93,5.02)
a AB C’ s data 2018- 2019.
b Olarte et al. 2015; E dmond et al. 2010Ag e 0-4 5+
Disability % b 7 (4, 11) 11 (8, 18)
Deafness % b 9 (7, 13) 14 (11, 22)Meningitis Sequelae
15IPD/NBP Serotype Distributions
Ag e 0 1 2 to 5 6+
% PCV 13 (+6C -3-19F) 3.68% 1.23% 9.76% 10.64%
% ST3 11.90% 3.68% 10.93% 14.22%
% ST19F 7.35% 7.37% 5.65% 9.17%
% PCV 15 only (ST 22F , 33F) 17.41% 21.01% 14.97% 14.14%
% PCV20 only 12.86% 19.78% 11.45% 13.52%
% PPSV23 only 1.84% 1.23% 0.73% 5.83%
% PCV 13 (+6C -3-19F) 3.06%
% ST3 3.06%
% ST19F 3.06%
% PCV 15 only (ST 22F , 33F) 8.16%
% PCV20 only (ST 8, 10A, 11A,
12F, 15B)23.47%AOM Serotype Distributions
IPD serotype distributions from AB Cs data 2018 -2019. Applied to NB P by assumption.
AOM serotyp e distrib utions from Kaur et al. 2022 modified by exp ert inp ut.
16Vaccine Prices
PCV 13 Private $226.43 CDC Price Listb
PCV13 Pub lic $158.18 CDC Price List
PCV 15 Private $216.086 CDC Price Listb
PCV15 Pub lic $162.27 CDC Price List
PCV20 Private $253.96 a
PCV20 Public $187.27 a
PPSV23 Private $117.08 CDC Price Listb
PPSV23 Public $65.80 CDC Price List
V accine Admin $30.13 Tsai Prev Med Reports 2019
Travel/Caregiver Time $35.96 Maciosek Am J Prev Med 2006
a Ratio of PCV20:PCV15 cost in adults sep arately for p ub lic and p rivate from CDC Price list and ap p lied to PCV15 costs in childr e n .
E stimation procedure discussed with manufacturer.
b Private list price inflated 7.1% to account for differences between C DC private list price and average reimbursement (L eidn er e t a l.
2021)
17Disease Cost ($)
Medical cost aNon-medical
cost b, c
Disability $258,084 ($206,467, $309,701) $1,413,847
Deafness $48,354 ($38,683, $58,025) $583,399
AOM $83 ($67, $100) $253
Tym p tube $3,610 ($2,888, $4,332) $253
IPD $19,196 ($15,357, $23,035) $624
IPD-mening $25,691 ($20,553, $30,829) $3,273
IPT NBP $10,965 ($8,772, $13,158) $624
OPT NBP $351 ($281, $421) $467
a Medical costs are from MarketScan 2004- 2006 data inflated to 2022$ using Medical component of CPI. R anges +/ - 20%.
b Disability & deafness: MMWR 53(03);57- 59 and Errata. E.g.: assistive devices, home modifications, sp ecial education costs,
p roductivity losses, etc.
c Other conditions: R ay et al. 2006 PIDJ
18QALY Decrements
AOM 0.0016 (0, 0.0155)
Tym p tube 0.0016 (0, 0.0155)
OPT NBP 0.0004 (0.0001, 0.0329)
IPT disease (not mening ) 0.0105 (0.0001, 0.0155)
IPD mening no sequelae 0.0165 (0.0001, 0.0166)
Deafness 0.2137 (0.07, 0.72)
Disability 0.2456 (0.16, 0.49)
QA L Y decrement are low, median, and high estimates from the survey by T ang et al. 2021. T he upper bound of A OM is capped at t he
upper bound of inpatient disease. T ympanostomy tube placement which follows Delgleize et al. 2016 in setting equal to AOM.
QA L Y decrements are scaled by background QA L Y values which range from 0.94 for age 0 to 0.92 for age 15 (E rickson et al. Stat istical
Notes 1995)
19Indirect Effects from Adult Program
Ba s e
(indirect rate =
3.17%)10% less effective
(indirect rate =
2.853%)Same effect as on
kids
(indirect rate = 7.8%)
Health Outcomes
IPD ca se s -182 -164 -447
I PT pneumonia cases -3,210 -2,889 -7,899
OPT pneumonia Cases -7,335 -6,601 -18,048
Deaths due to I PD -24 -21 -59
Deaths due to pneumonia -127 -115 -314
Q A LYs 1,262 1,136 3,105
Life-years 1,849 1,664 4,549
Costs (million $)
T otal cost -$80 -$72 -$197
Medical costs -$80 -$72 -$197
V accine costs $0 $0 $0
20Policy Questions
1.PCV20 in place of existing conjugate vaccines among
all risk groups.
2.PCV20 in place of existing schedules that include
conjugate and polysaccharide among CMC & IC
populations
21Direct Swap PCV20 for PCV13
PCV 20 vs PCV 13PCV 20+PPSV vs
PCV 13+PPSVPCV 20+PPSV +PPSV vs
PCV 13+PPSV +PPSV
Healthy CMC IC
IPD meningitis cases -55 -8 -1
IPD n o n -meningitis cases -276 -40 -3
Deafness -4 -1 0
Disab ility -6 -1 0
I PT pneumonia cases -1,106 -277 -7
OPT pneumonia cases -1,798 -1,552 -18
AOM ca s e s -145,371 -36,645 -444
Ty m p tubes -14,647 -3,815 -46
Deaths due to I PD -14 -2 0
Deaths due to pneumonia -8 -2 0
Childhood QAL Ys 917 190 7
Adult QAL Ys (indirect) 1,039 215 8
Life-years 685 128 7
Costs (million $)
T otal cost $153 -$17 -$0.92
Medical costs -$108 -$27 -$0.56
Non-medical costs -$52 -$13 -$0.27
Adult costs (indirect) -$66 -$14 -$0.53
V accine costs $379 $37 $0.44
Cost ratios ($)
C o s t / Q A LY 78,115 Cost-saving Cost-saving
Cost/life -year 223,192 Cost-saving Cost-savingPolicy Question 1
22Direct Swap PCV20 for PCV15
PCV 20 vs PCV 15
HealthyPCV 20+PPSV vs
PCV 15+PPSV
CMCPCV 20+PPSV +PPSV vs
PCV 15+PPSV +PPSV
IC
IPD menigitis cases -25 -4 0
IPD n o n -meningitis cases -125 -18 -2
Deafness -2 0 0
Disab ility -3 0 0
I PT pneumonia cases -500 -126 -3
OPT pneumonia cases -824 -716 -8
AOM ca s e s -107,856 -27,188 -329
Ty m p tubes -10,867 -2,830 -34
Deaths due to I PD -7 -1 0
Deaths due to pneumonia -4 -1 0
Childhood QAL Ys 488 104 4
Adult QAL Ys (indirect) 1,033 221 8
Life-years 308 58 3
Costs (million $)
T otal cost $234 -$1 -$0.48
Medical costs -$68 -$17 -$0.32
Non-medical costs -$35 -$9 -$0.16
Adult costs (indirect) -$65 -$14 -$0.48
V accine costs $402 $39 $0.47
Cost ratios ($)
C o s t / Q A LY 153,715 Cost-saving Cost-saving
Cost/life -year 757,901 Cost-saving Cost-savingPolicy Question 1
23Direct Swap PCV20 for PCV15
Sensitivity Analysis: PCV20 VE 10% Lower
PCV 20 vs PCV 15 PCV 20+PPSV vs
PCV 15+PPSV PCV 20+PPSV +PPSV vs
PCV 15+PPSV +PPSV
Healthy CMC IC
IPD meningitis cases -16 -2 0
IPD n o n -meningitis cases -82 -10 -1
Deafness -1 0 0
Disab ility -2 0 0
IPT pneumonia cases -392 -95 -2
OPT pneumonia cases -651 -542 -6
AOM cases -85,628 -21,597 -262
Ty m p tubes -8,633 -2,250 -27
Deaths due to I PD -4 -1 0
Deaths due to pneumonia -3 -1 0
Childhood QAL Ys 360 76 2
Adult QAL Ys (indirect) 933 197 6
Life-years 216 39 2
Costs (million $)
T otal cost $263 $6 -$0.22
Medical costs -$53 -$13 -$0.22
Non-medical costs -$27 -$7 -$0.11
Adult costs (indirect) -$59 -$12 -$0.36
V accine costs $402 $39 $0.47
Cost ratios ($)
C o s t / Q A LY 203,365 23,832 Cost-saving
Cost/life -year 1,216,977 168,181 Cost-savingPolicy Question 1
24Direct Swap PCV20 for PCV15
Sensitivity Analysis: Adult Indirect Effects 7.8%
PCV 20 vs PCV 15 PCV 20+PPSV vs
PCV 15+PPSV PCV 20+PPSV +PPSV vs
PCV 15+PPSV +PPSV
Healthy CMC IC
IPD meningitis cases -25 -4 0
IPD n o n -meningitis cases -125 -18 -2
Deafness -2 0 0
Disab ility -3 0 0
IPT pneumonia cases -500 -126 -3
OPT pneumonia cases -824 -716 -8
AOM cases -107,856 -27,188 -329
Ty m p tubes -10,867 -2,830 -34
Deaths due to I PD -7 -1 0
Deaths due to pneumonia -4 -1 0
Childhood QAL Ys 488 104 4
Adult QAL Ys (indirect) 2,542 545 19
Life-years 308 58 3
Costs (million $)
T otal cost $138 -$21 -$1.18
Medical costs -$68 -$17 -$0.32
Non-medical costs -$35 -$9 -$0.16
Adult costs (indirect) -$161 -$35 -$1.17
V accine costs $402 $39 $0.47
Cost ratios ($)
C o s t / Q A LY 45,551 Cost-saving Cost-saving
Cost/life -year 447,389 Cost-saving Cost-savingPolicy Question 1
25Direct Swap PCV20 for PCV15, Healthy
Multivariate Sensitivity, 90% Confidence Interval
PCV 20 vs PCV 15 5th 95th
Healthy Healthy Healthy
IPD meningitis cases -25 -28 -21
IPD n o n -meningitis cases -125 -135 -104
Deafness -2 -3 -1
Disab ility -3 -4 -2
IPT pneumonia cases -500 -829 -82
OPT pneumonia cases -824 -1,363 -136
AOM cases -107,856 -130,202 -87,612
Ty m p tubes -10,867 -14,286 -7,866
Deaths due to I PD -7 -8 -5
Deaths due to pneumonia -4 -6 -1
Childhood QAL Ys 488 362 1,263
Adult QAL Ys (indirect) 1,033 402 2,541
Life-years 308 206 388
Costs (million $)
T otal cost $234 $135 $279
Medical costs -$68 -$85 -$49
Non-medical costs -$35 -$42 -$30
Adult costs (indirect) -$65 -$162 -$24
V accine costs $402 $401 $404
Cost ratios ($)
C o s t / Q A LY 153,715 51,105 210,518
Cost/life -year 757,901 409,958 1,144,176Policy Question 1
26Direct Swap PCV20 for PCV15, Healthy
One-way Sensitivity
Influential Inputs on Cost/QALY
All inp uts were included in multivariate sensitivity analysis. The top 5 according to size of change in cost p er QAL Y are ch arted
here. E nds of bars represent the cost/QA L Y when the particular input is set to the min/max (or 5th & 9 5th) of the input
distrib ution. $- $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000VE PCV vs AoM !ST3 !ST19IPT NBP due to pneumococcusAoM QALY DecrementIndirect Adult CostsIndirect Adult QALYsPolicy Question 1
27PCV20 without PPSV23, PCV13 Context
PCV 20 vs PCV 13+PPSV PCV 20 vs PCV 13+PPSV +PPSV
CMC IC
IPD meningitis cases -7 -1
IPD n o n -meningitis cases -35 -3
Deafness -1 0
Disab ility -1 0
I PT pneumonia cases -267 -6
OPT pneumonia cases -1,497 -17
AOM ca s e s -36,645 -444
Ty m p tubes -3,815 -46
Deaths due to I PD -2 0
Deaths due to pneumonia -2 0
Childhood QAL Ys 180 6
Adult QAL Ys (indirect) 204 7
Life-years 118 6
Costs (million $)
T otal cost -$55 -$1.57
Medical costs -$27 -$0.51
Non-medical costs -$12 -$0.24
Adult costs (indirect) -$13 -$0.45
V accine costs -$3 -$0.38
Cost ratios ($)
C o s t / Q A LY Cost-saving Cost-saving
Cost/life -year Cost-saving Cost-savingPolicy Question 2
28PCV20 without PPSV23, PCV15 Context
PCV 20 vs
PCV 15+PPS
CMC
VPCV 20 vs
PCV 15+PPSV +PPSV
ICPCV 20 vs PCV 15+PPSV ,
Half PPSV Coverage
CMCPCV 20 vs
PCV 15+PPSV +PPSV ,
Half PPSV Coverage
IC
IPD meningitis cases -3 0 -4 0
IPD n o n -meningitis cases -13 -1 -21 -2
Deafness 0 0 0 0
Disab ility 0 0 0 0
IPT pneumonia cases -116 -2 -138 -3
OPT pneumonia Cases -661 -7 -786 -9
AOM cases -27,188 -329 -27,188 -329
Ty m p tubes -2,830 -34 -2,830 -34
Deaths due to I PD -1 0 -1 0
Deaths due to pneumonia -1 0 -1 0
Childhood QAL Ys 95 3 111 4
Adult QAL Ys (indirect) 108 3 125 5
Life-years 48 2 64 4
Costs (million $)
T otal cost -$33 -$0.91 $4 -$0.66
Medical costs -$17 -$0.26 -$18 -$0.34
Non-medical costs -$8 -$0.12 -$9 -$0.18
Adult costs (indirect) -$7 -$0.18 -$8 -$0.29
V accine costs -$1 -$0.35 $39 $0.15
Cost ratios ($)
C o s t / Q A LY Cost-saving Cost-saving 18,722 Cost-saving
Cost/life -year Cost-saving Cost-saving 68,612 Cost-savingPolicy Question 2
29Adding PPSV23 to a PCV20 Primary Series
PCV 20+PPSV vs PCV 20PCV 20+PPSV +PPSV vs
P CV2 0
CMC IC
IPD meningitis cases -1 0
IPD n o n -meningitis cases -5 -1
Deafness 0 0
Disab ility 0 0
I PT pneumonia cases -10 -1
OPT pneumonia cases -55 -1
AOM ca s e s 0 0
Ty m p tubes 0 0
Deaths due to I PD 0 0
Deaths due to pneumonia 0 0
Q A LYs 9 1
Life-years 10 1
Costs (million $)
T otal cost 39 $0.73
Medical costs -1 -$0.06
Non-medical costs 0 -$0.04
V accine costs 40 $0.82
Cost ratios ($)
S a v i n g s / Q A LY 4,086,881 690,388
Savings/life -year 3,923,758 658,925Policy Question 2
30Limitations
Uncertainty around indirect effects on adults
Uncertainty around QALY decrements
AOM
PCV20 VE based on immunogenicity trials
Sa m e VE fo r a ll P CV valencies
ST3 VE limited data
31Conclusion
Policy Question 1
Replacing PCV13 with PCV20 costs:
$57k/QAL Y (aggregate)
•$78k/QAL Y (healthy)
•Co st -savin g (CMC)
•Co st -Saving (IC)
Replacing PCV15 with PCV20 costs:
$125k/QAL Y (aggregate)
•$154k/QAL Y (healthy)
•Co st -savin g (CMC)
•Co st -sa vin g (IC)
32Replacing PCV13+PPSV23 (or PCV15+PPSV23) with PCV20
by itself in CMC/IC is cost saving
Adding PPSV23 to PCV20 for CMC/IC costs:
$3.9 million/QAL Y (aggregate)
•$4.1 million/QAL Y (CMC)
•$0.7 million/QAL Y (IC)Conclusion
Policy Question 2
33Thank you!
Please send comments to:
[email protected]
Contributors:
Miwako Kobayashi
Dipreye Ayabina
Namrata Prasad
Andrew Leidner
H
SREB – Ec o n Te a mNational Center for Immunization & Resp iratory Diseases