Cost-effectiveness and impact on infections and associated antimicrobial resistance of 20-valent pneumococcal conjugate vaccine in US children previously immunized with PCV13

Figures & data

Figure 1. Model structure. Although not shown on the diagram, it is possible to recover from all disease states. Abbreviations. OM, otitis media; IPD, invasive pneumococcal disease; SoC, standard of care.

Table 1. Results of the base-case analysis.

Outcomes	PCV20 3 + 1	PCV20 3 + 1 with supplemental dose	Incremental results
Cases of IPD	280,946	275,477	−5,469
Cases of all-cause hospitalized pneumonia	15,305,379	15,255,093	−50,286
Cases of all-cause non-hospitalized pneumonia	44,664,825	44,446,585	−218,240
Cases of all-cause OM	142,227,850	141,645,548	−582,302
Number of deaths due to disease	913,229	911,429	−1,800
Total vaccine doses	117,987,473	125,958,961	7,971,488
Total direct cost of doses	$23,074,249,162	$24,845,640,264	$1,771,391,101
Total direct cost of disease	$599,961,145,529	$597,841,078,235	−$2,120,067,294
Total direct lifetime cost of sequalae	$599,272,759	$585,239,679	−$14,033,080
Total indirect cost of disease	$87,050,897,548	$86,616,124,882	−$434,772,665
Total indirect lifetime cost of sequalae	$242,608,571	$236,897,299	−$5,711,273
Total costs	$710,928,173,569	$710,124,980,359	−$803,193,210
Total QALYs	7,093,303,289	7,093,358,872	55,583
Total LYs	8,400,434,759	8,400,464,773	30,014
ICER per QALY—payer perspective	Dominant
ICER per QALY—societal perspective	Dominant

Abbreviations. IPD, invasive pneumococcal disease; LY, life year; OM, otitis media; PCV20, 20-valent pneumococcal conjugate vaccine; QALY, quality-adjusted life year.

Figure 2. Results of the deterministic sensitivity analysis. (a) Cost results. Costs are displayed in billions. (b) QALY results. Abbreviations. DSA, deterministic sensitivity analysis; IPD, invasive pneumococcal disease; PCV20, 20-valent pneumococcal conjugate vaccine; QALY, quality-adjusted life year; SOC, standard of care.

Figure 3. Results of the probabilistic sensitivity analysis. Light yellow circles show the results of each iteration of the PSA; dark yellow diamond shows the mean of 1,000 iterations. Abbreviations. PCV20, 20-valent pneumococcal conjugate vaccine; QALY, quality-adjusted life year.

Table 2. Scenario analysis: accrual of indirect effects with supplemental dose reduced by 25%.

Outcomes	PCV20 3 + 1	PCV20 3 + 1 with supplemental dose	Incremental results
Cases of IPD	280,946	276,701	−4,245
Cases of all-cause hospitalized pneumonia	15,305,379	15,264,915	−40,464
Cases of all-cause non-hospitalized pneumonia	44,664,825	44,493,275	−171,550
Cases of all-cause OM	142,227,850	141,738,993	−488,857
Number of deaths due to disease	913,229	911,846	−1,383
Total vaccine doses	117,987,473	125,958,961	7,971,488
Total direct cost of doses	$23,074,249,162	$24,845,637,614	$1,771,388,451
Total direct cost of disease	$599,961,145,529	$598,289,970,630	−$1,671,174,899
Total direct lifetime cost of sequalae	$599,272,759	$588,222,679	−$11,050,080
Total indirect cost of disease	$87,050,897,548	$86,689,185,793	−$361,711,755
Total indirect lifetime cost of sequalae	$242,608,571	$238,105,526	−$4,503,046
Total costs	$710,928,173,569	$710,651,122,241	−$277,051,328
Total QALYs	7,093,303,289	7,093,346,701	43,412
ICER cost per QALY	Dominant

Abbreviations. ICER, incremental cost-effectiveness ratio; IPD, invasive pneumococcal disease; LY, life year; OM, otitis media; PCV20, 20-valent pneumococcal conjugate vaccine; QALY, quality-adjusted life year.

Data availability statement

All data analyzed in this study are included within the article or Supplementary Material.