Estimating the population health and economic impacts of introducing a pneumococcal conjugate vaccine in Malaysia- an economic evaluation

ABSTRACT

Pneumococcal disease is a potentially fatal bacterial infection that is vaccine-preventable. Malaysia has yet to adopt a pneumococcal conjugate vaccine (PCV) into its national immunization program (NIP). In 2016, pneumonia was the 3^rd leading cause of death in children under five in Malaysia, accounting for 3.8% of under-five deaths. Introducing a pneumococcal conjugate vaccine (PCV) is an effective strategy to reduce the disease burden. This study used a decision-analytic model to assess the potential impacts of introducing the available PCVs (13-valent and 10-valent) in Malaysia. Epidemiological and costs inputs were sourced from published literature. For each vaccination program, health outcomes and associated healthcare costs were estimated. The scenarios of initiating PCV13 vs. PCV10 and the status quo (no pneumococcal vaccine) were compared. Serotype trends of Finland and the U.K. were used to model the clinical impacts of PCV10 and PCV13 respectively. The base-case analysis used a societal perspective over a 5-year time horizon. Compared with PCV10, PCV13 was projected to avert an additional 190,628 cases of pneumococcal disease and 1126 cases of death. The acquisition of PCV13 was estimated to cost an incremental US$89,904,777, offset by a cost reduction of -US$250,219,914 on pneumococcal disease-related medical care and lost productivity. PCV13 demonstrated a higher cost-saving potential over PCV10. Compared with no vaccination, PCV13 was estimated as cost-saving. Results were robust across a series of sensitivity analyses. The introduction of PCV13 in a NIP was estimated to reduce a significant burden of disease and to be a cost-saving for the Malaysian health system.

KEYWORDS:

• Cost-effectiveness
• decision analytic model
• pneumococcal disease
• pneumococcal conjugate vaccine
• Malaysia

Disclosure of potential conflicts of interest

SP and JN are employees of Pfizer. SP is a shareholder of Pfizer. CYF and CW are employees of IQVIA. IQVIA received professional fees from Pfizer for the supportive services related to this study. The rest of the authors reported no conflict of interest.

Contributors

SP, AAS, JN conceived and designed the analysis; NA, JN, SP collected the data; AAS, NA, JN, CYF, CW, SP, KKT analysed and/or interpreted the results; CYF, CW, SP wrote the first draft; AAS, NA, JN, CYF, CW, SP, KKT critically reviewed the content and approved the final version.

Data sharing

Data used for the analyses are available on request.

Transparency

The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21645515.2019.1701911.

Additional information

Funding

This study was funded by Pfizer Inc.