ISPOR Europe 2018
Barcelona, Spain
November, 2018
PIN34
Infection all, Multiple Diseases/No Specific Disease
Cost Studies (CS)
Cost-Effectiveness Analysis (CE)
COMPARING THE ESTIMATED PUBLIC HEALTH IMPACT AND COST-EFFECTIVENESS OF PHID-CV AND PCV-13 IN THE ROUTINE IMMUNISATION PROGRAMME IN GAVI-ELIGIBLE COUNTRIES (SUB-SAHARAN AFRICA AND ASIA/OCEANIA): A MODELLING STUDY
Sauboin C1, Vargas-Zambrano JC2, Marijam A3, Lorenc S4, Oladehin O5, Adegbola R3
1GSK, Nairobi, Kenya, 2GSK, Toronto, ON, Canada, 3GSK, Wavre, Belgium, 4Freelance on behalf of GSK, Wavre, Belgium, 5GSK, Lagos, Nigeria
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).