Health and economic impact of PHiD-CV in Canada and the UK: a Markov modelling exercise

Abstract

Objective:

The spectrum of diseases caused by Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) represents a large burden on healthcare systems around the world. Meningitis, bacteraemia, community-acquired pneumonia (CAP), and acute otitis media (AOM) are vaccine-preventable infectious diseases that can have severe consequences. The health economic model presented here is intended to estimate the clinical and economic impact of vaccinating birth cohorts in Canada and the UK with the 10-valent, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared with the newly licensed 13-valent pneumococcal conjugate vaccine (PCV-13).

Methods:

The model described herein is a Markov cohort model built to simulate the epidemiological burden of pneumococcal- and NTHi-related diseases within birth cohorts in the UK and Canada. Base-case assumptions include estimates of vaccine efficacy and NTHi infection rates that are based on published literature.

Results:

The model predicts that the two vaccines will provide a broadly similar impact on all-cause invasive disease and CAP under base-case assumptions. However, PHiD-CV is expected to provide a substantially greater reduction in AOM compared with PCV-13, offering additional savings of Canadian $9.0 million and £4.9 million in discounted direct medical costs in Canada and the UK, respectively.

Limitations:

The main limitations of the study are the difficulties in modelling indirect vaccine effects (herd effect and serotype replacement), the absence of PHiD-CV- and PCV-13-specific efficacy data and a lack of comprehensive NTHi surveillance data. Additional limitations relate to the fact that the transmission dynamics of pneumococcal serotypes have not been modelled, nor has antibiotic resistance been accounted for in this paper.

Conclusion:

This cost-effectiveness analysis suggests that, in Canada and the UK, PHiD-CV’s potential to protect against NTHi infections could provide a greater impact on overall disease burden than the additional serotypes contained in PCV-13.

Key words::

• Pneumococcal infections
• Economics
• Epidemiology
• Prevention & control
• Pneumococcal vaccines
• Health economic models

Transparency

Declaration of funding

GlaxoSmithKline Biologicals was the funding source and was involved in all stages of the study and analysis. GlaxoSmithKline Biologicals also took responsibility for all costs associated with the development and publishing of the present manuscript. Gerhart Knerer was involved with the design of the model and validation of assumptions. David W Pearce and Afisi Ismaila were responsible for adapting the model to the UK and Canada.

Declaration of financial/other relationships

All authors are employees of GlaxoSmithKline Biologicals.

Acknowledgements

Editorial assistance was provided by Ben Holtom (Fishawack Communications Ltd.) and Jenny Lloyd during the preparation of this manuscript. Abdelilah Ibrahimi (XPE Pharma and Science for GlaxoSmithKline Biologicals), Elhem Sbaa, Paul Kenny, Oleksandr Topachevskyi, and Julie Roiz of GlaxoSmithKline Biologicals provided assistance with manuscript coordination and editing and technical support. Financial support was provided by GlaxoSmithKline. The authors thank Laure-Anne Van-Bellinghen at Deloitte for help with the development of the model. The authors are grateful to the experts who attended the series of GlaxoSmithKline PHiD-CV Health Economics roundtable meetings (Dublin, October 2007; Montreal, March 2008; and Reykjavik, June 2008) that helped to inform the assumptions used during the course of the GlaxoSmithKline Pneumococcal Health Economic model-design process.