Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination

• Published in: BMC health services research Vol. 14; no. 1; p. 56
• Main Authors: Che, Datian, Zhou, Hua, He, Jinchun, Wu, Bin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.02.2014; BioMed Central
• Subjects: Age; Antibiotics; Babies; Child, Preschool; Children & youth; China - epidemiology; Comparative analysis; Cost of Illness; Cost-Benefit Analysis; Costs; Decision Trees; Drug dosages; Drug resistance; Ear diseases; Economic analysis; Economic aspects; Epidemiology; Fatalities; Health aspects; Health Care Costs - statistics & numerical data; Health insurance; Health surveillance; Heptavalent Pneumococcal Conjugate Vaccine; Herd immunity; Hospitals; Humans; Immunity, Herd; Immunization; Industrialized nations; Infant; Infants; Mandatory Programs - economics; Meningitis; Methods; Models, Economic; Otolaryngology; Pneumococcal Infections - economics; Pneumococcal Infections - mortality; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - economics; Pneumococcal Vaccines - therapeutic use; Pneumonia; Probability; Public health; Quality-Adjusted Life Years; Sensitivity analysis; Streptococcus infections; Streptococcus pneumoniae; Surveillance; Treatment Outcome; Vaccines; Vaccines, Conjugate - economics; Vaccines, Conjugate - therapeutic use; China; United Kingdom
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-14-56

The purpose of this study was to compare, from a Chinese societal perspective, the projected health benefits, costs, and cost-effectiveness of adding pneumococcal conjugate heptavalent vaccine (PCV-7) to the routine compulsory child immunization schedule. A decision-tree model, with data and assumptions adapted for relevance to China, was developed to project the health outcomes of PCV-7 vaccination (compared with no vaccination) over a 5-year period as well as a lifetime. The vaccinated birth cohort included 16,000,000 children in China. A 2 + 1 dose schedule at US$136.51 per vaccine dose was used in the base-case analysis. One-way sensitivity analysis was used to test the robustness of the model. The impact of a net indirect effect (herd immunity) was evaluated. Outcomes are presented in terms of the saved disease burden, costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio. In a Chinese birth cohort, a PCV-7 vaccination program would reduce the number of pneumococcus-related infections by at least 32% and would prevent 2,682 deaths in the first 5 years of life, saving $1,190 million in total costs and gaining an additional 9,895 QALYs (discounted by 3%). The incremental cost per QALY was estimated to be $530,354. When herd immunity was taken into account, the cost per QALY was estimated to be $95,319. The robustness of the model was influenced mainly by the PCV-7 cost per dose, effectiveness herd immunity and incidence of pneumococcal diseases. With and without herd immunity, the break-even costs in China were $29.05 and $25.87, respectively. Compulsory routine infant vaccination with PCV-7 is projected to substantially reduce pneumococcal disease morbidity, mortality, and related costs in China. However, a universal vaccination program with PCV-7 is not cost-effective at the willingness-to-pay threshold that is currently recommended for China by the World Health Organization.