A systematic literature review of economic evaluations of pneumococcal conjugate vaccines in east and southeast Asia (2006-2019)

Figures & data

Figure 1. Study Selection Abbreviations: PCV=Pneumococcal Conjugate Vaccine

Table 1. Overview of Included Studies

STUDY	SETTING	FUNDER	STUDY TYPE	PERSPECTIVE	POPULATION	VACCINE COVERAGE	TIME HORIZON	DISCOUNT RATE
Nakamura et al. 2011	Middle- Income Countries	GAVI	CUA	Societal	Under 5-year olds	Variable	Lifetime	3.0%
Tasslimi et al. 2011	Global Analysis	GAVI	CUA	Societal	Under 5-year olds	Variable	Lifetime	3.0%
Chen et al. 2019	GAVI-Eligible	WHO, GAVI, BMGF	CUA	Health systems	30 birth cohorts in 180 countries	Variable – DPT3 coverage	Lifetime (implied)	3.0%
Che et al. 2014	China	Shanghai Jiaotong University SOM	CUA	Societal	1 birth cohort	99%	100 years	3.0%
Hu et al. 2014	China	Pfizer	CUA	Payer	Birth cohort	68%, 73%, up to 83% (by implication and citation)	1 year of costs occurring 5 – 7 years into the future	5.0%
Caldwell et al. 2015	China	Pfizer	CUA	Payer	Whole Chinese population	85%	1 year for intervention, LT for costs and outcomes	3.0%
Maurer et al. 2016	China	None	CUA	Societal	Cohort of 16m Chinese infants	100%	5 years (infections) and lifetime for effects of infections	3.0%
Mo et al. 2016	China	Unclear	CUA	Societal (by report) but no indirect costs	100,000 newborns	20%	100 years	3.0%
Shen et al. 2018	China	Pfizer	CUA	Payer	One birth cohort	85%	Lifetime	3.0%
Zhou et al. 2018	China	Shanghai Health and Family Planning Commission	CUA	Payer and Societal	One birth cohort	83.27%	Lifetime	5.0%
Aljunid et al. 2011	Malaysia	Pfizer	CEA	Payer (healthcare system)	550,000 infants	90%	10 years	3.0%
Aljunid et al. 2014	Malaysia	GSK	CUA	Payer (Malaysia MOH)	Birth cohort (550,000 infants)	95%	Lifetime	5% C&O
Wang et al. 2017	Malaysia	GSK	CUA	Payer (Malaysia MOH)	Birth cohort	100%	10 years	3% (0 - 5% in SA)
Wu et al. 2016	Malaysia	Pfizer	CUA	Payer and Societal	10 successive birth cohorts	Hong Kong - 95%; Malaysia - 98-99%	10 years	0.03
Lee et al. 2013	Hong Kong	GSK	CEA/CUA	Payer	Birth cohort (82,100)	PCV-10 - 68.6% (<5), 66.7% (5 - 17), 53.3% (18 - 64), 47.0% (>65); PCV-13 - 91.4%, 73.3%, 78.3%, and 71.6%	10 years	5.0%
Lee et al. 2009	Hong Kong	Wyeth	CEA	Payer and Societal	Birth cohort (57,100 infants)	95%	10 years	5% C&O
Hoshi et al. 2012	Japan	The Ministry of Health, Labor and Welfare	CUA	Societal	Birth cohort (1,000 births)	80% (no co-pay), 65% ($13 co-pay)	5 years	3% for C&O
Hoshi et al. 2013	Japan	The Ministry of Health, Labor and Welfare	CEA/CUA	Societal	Birth cohort (1,000 births)	76.1%	5 years	3% for C&O
Shiragami et al. 2015	Japan	GSK	CUA	Healthcare provider and societal	Birth cohort (1,042,000 new-born)	100%	5 years	3% for C&O
Sohn et al. 2010	Korea	None	CEA	Societal	Birth cohort (451,514 infants)	Not Stated	5 years	5% C&O
Zhang et al. 2018	Korea	GSK	CUA	Governmental	2012 birth cohort	99%	10 years	5% C&O
Krishnamoorthy et al. 2019	India	None	CUA (/DALY averted)	Governmental	10 birth cohorts	91%, 88%, and 88% for 1st, 2nd and 3rd doses	10 years	3% for C&O
Megiddo et al. 2018	India	BMGF	ECEA	Health system	25,000 individuals/4300 households	77% (DPT coverage); 90% (expanded coverage)	20 years	3% (costs)
Wu et al. 2012	Taiwan	National Science Council	CEA	Healthcare & Societal	Total Population	90%	10 Years	3% for C&O
Wu et al. 2013	Taiwan	Taiwanese National Science Council	CEA	Payer and Societal	Birth cohort (191,310 infants)	90%	10 years	3% for C&O
Dilokthornsakul et al. 2019	Thailand	Pfizer	CUA	Societal	Hypothetical birth cohort of 100,000	74.1% in children < 5 years	Lifetime	0.03
Kulpeng et al. 2013	Thailand	The Thai Health Promotion Foundation	CUA	Societal	Unclear	99%	Lifetime	3% for C&O
Haasis et al. 2015	Philippines	Rockefeller Foundation, NICE International, HITAP, Dept. of Health (Philippines)	CUA	Health system	Birth cohort (2 million infants)	2 scenarios: 100% and 25%	Lifetime	3.5% C&O
Zhang et al. 2014	Philippines	GSK	CUA	Governmental	birth cohort in 2012 of 1,812,137	100% (by design)	Lifetime	5.0%
Tyo et al. 2011	Singapore	MOH	CUA	Healthcare	Infant and child cohort (226,000)	95%	5 years	3% for C&O
Sundaram et al. 2017	Mongolia	WHO/GAVI	CUA (/DALY averted)	Health system and Societal	30 birth cohorts	98.2% (1st dose), 97.9 (2nd doses), and 97.6% (3rd dose)	100 years	3% for C&O
Dorji et al. 2018	Bhutan	HITAP (Thailand Research Fund)	CUA	Governmental	1 birth cohort (2016)	97%	Lifetime	3%

Abbreviations: BMGF=Bill & Malinda Gates Foundation; CEA=Cost-Effectiveness Analysis; C&O=Costs and Outcomes; CUA=Cost-Utility Analysis; DALY=Disability Adjusted Life-Years; DPT3= 3^rd Dose Diphtheria, Pertussis, and Tetanus Vaccine; ECEA=Extended Cost-Effectiveness Analysis; GAVI=Gavi, The Vaccine Alliance; GSK=GlaxoSmithKline; HITAP=Health, Intervention and Technology Assessment Program; LT= lifetime; MOH=Ministry of Health; NICE=The National Institute for Healthcare Excellence; PCV=Pneumococcal Conjugate Vaccine; SA=Sensitivity Analysis; WHO=World Health Organization

Table 2. Cost-Effectiveness Results

STUDY	SETTING	COMPARISON	OUTCOME	RESULT	NIP STATUS
Nakamura et al. 2011	Middle-Income Countries	PCV7 vs. No Vaccination	$1,600 / DALY Averted	Cost-Effective	-----
		PCV10-GSK vs. No Vaccination	$1,000 / DALY Averted	Cost-Effective
		PCV13-PFE vs. No Vaccination	$900 / DALY Averted	Cost-Effective
Tasslimi et al. 2011	Global Analysis	PCV7 vs. No Vaccination	$146 / DALY Averted	Cost-Effective	-----
		PCV10-GSK vs. No Vaccination	$88 / DALY Averted	Cost-Effective
		PCV13-PFE vs. No Vaccination	$77 / DALY Averted	Cost-Effective
Chen et al. 2019	GAVI-Eligible	PCV13-PFE vs. No Vaccination	I$853 / DALY Averted	Cost-Effective	-----
Che et al. 2014	China	PCV7 vs. No Vaccination	$530,354 / QALY (No Herd Effect)	Not Cost-Effective	None
			$95,319 / QALY (Herd Considered)	Not Cost-Effective
Hu et al. 2014	China	PCV7 vs. No Vaccination	$6,435 / QALY	Cost-Effective	None
Caldwell et al. 2015	China	PCV7 vs. No Vaccination	$2,125 / QALY	Cost-Effective	None
Maurer et al. 2016	China	PCV7 vs. No Vaccination	$18,224 / QALY	Cost-Effective	None
		PCV10-GSK vs. No Vaccination	$16,664 / QALY	Cost-Effective
		PCV13-PFE vs. No Vaccination	$11,436 / QALY	Cost-Effective
Mo et al. 2016	China	PCV7 vs. No Vaccination	$104,094 / QALY	Not Cost-Effective	None
		PCV13-PFE vs. No Vaccination	$29,460 / QALY	Cost-Effective
Shen et al. 2018	China	PCV13-PFE vs. No Vaccination	¥79,304/QALY (direct)	Cost-Effective	None
			¥76,551/QALY (direct + indirect IPD)	Cost-Effective
			¥3,777/QALY (direct + indirect IPD and PNE)	Cost-Effective
Zhou et al. 2018	China	PCV13-PFE vs. No Vaccination	$20,709 / QALY (Healthcare)	Cost-Effective	None
			$18,483 / QALY (Societal)	Cost-Effective
Aljunid et al. 2011	Malaysia	PCV7 vs. No Vaccination	$10,261 / QALY	Cost-Effective	None
Aljunid et al. 2014	Malaysia	PCV10-GSK vs. No Vaccination	$9,406 / QALY	Cost-Effective	None
		PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective
Wang et al. 2017	Malaysia	PCV10-GSK vs. No Vaccination	$28,497 / QALY	Cost-Effective	None
		PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective
Wu et al. 2016	Malaysia	PCV10-GSK vs. No Vaccination	$21,438 / QALY (Payer)	Cost-Effective	None
			$20,667 / QALY (Societal)	Cost-Effective
		PCV13-PFE vs. No Vaccination	$6,389 / QALY (Payer)	Cost-Effective
			$4,883 / QALY (Societal)	Cost-Effective
		PCV13-PFE vs. No Vaccination	Dominant (Payer)	Cost-Effective
			Dominant (Societal)	Cost-Effective
	Hong Kong	PCV10-GSK vs. No Vaccination	$46,832 / QALY (Payer)	Cost-Effective
			$40,923 / QALY (Societal)	Cost-Effective
		PCV13-PFE vs. No Vaccination	Dominant (Payer)	Cost-Effective	PCV13-PFE
			Dominant (Societal)	Cost-Effective
		PCV13-PFE vs. No Vaccination	Dominant (Payer)	Cost-Effective
			Dominant (Societal)	Cost-Effective
Lee et al. 2013	Hong Kong	PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective	PCV13-PFE
Lee et al. 2009	Hong Kong	PCV7 vs. No Vaccination	$6,460 / LYG (Payer)	Cost-Effective	PCV13-PFE
			$5,929 / LYG (Societal)	Cost-Effective
Hoshi et al. 2012	Japan	PCV7 vs. No Vaccination	$93,013 / QALY (Vaccinated Alone)	Cost-Effective	PCV13-PFE
			$93,013 / QALY (Co-Vaccination)	Cost-Effective
Hoshi et al. 2013	Japan	PCV7 vs. No Vaccination	¥6,352,110 (Base Case A; Payer)	Cost-Effective	PCV13-PFE
			¥6,352,110 (Base Case B; Payer)	Cost-Effective
			¥1,588,575 (Base Case A; Societal)	Cost-Effective
			¥1,588,575 (Base Case B; Societal)	Cost-Effective
		PCV13-PFE vs. No Vaccination	¥9,034,940 (Base Case A; Payer)	Cost-Effective
			¥4,368,278 (Base Case B; Payer)	Cost-Effective
			¥4,495,903 (Base Case A; Societal)	Cost-Effective
			Dominant (Base Case B; Societal)	Cost-Effective
		PCV13-PFE vs. PCV7	¥37,722,901 (Base Case A; Payer)	Not Cost-Effective
			¥343,830 (Base Case B; Payer)	Cost-Effective
			¥35,584,455 (Base Case A; Societal)	Not Cost-Effective
			Dominant (Base Case B; Societal)	Cost-Effective
Shiragami et al. 2015	Japan	PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective	PCV13-PFE
Sohn et al. 2010	Korea	PCV7 vs. No Vaccination	$115,549 (4-Dose Schedule);	Not Cost-Effective	PCV10-GSK & PCV13-PFE
			$79,955 (3-Dose Schedule)	Not Cost-Effective
Zhang et al. 2018	Korea	PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective	PCV10-GSK & PCV13-PFE
Krishnamoorthy et al. 2019	India	PCV13-PFE vs. No Vaccination	$467 / DALY Averted	Cost-Effective	PCV13-PFE*
Megiddo et al. 2018	India	PCV13-PFE vs. No Vaccination	$144 per YLL averted (current coverage)	Cost-Effective	PCV13-PFE*
			$127 per YLL averted (expanded coverage)	Cost-Effective
Wu et al. 2012	Taiwan	PCV13-PFE vs. No Vaccination	$38,045 / LYG (Four Dose; Payer)	Cost-Effective	PCV13-PFE
			$18,299 LYG (Four Dose; Societal)	Cost-Effective
			$22,050 LYG (Three-Dose; Payer) and	Cost-Effective
			$2,304 LYG (Three-Dose; Societal)	Cost-Effective
Wu et al. 2013	Taiwan	PCV7 vs. No Vaccination	NT$1,183,028 / LY (payer)	Cost-Effective	PCV13-PFE
			NT$619,862 / LY (societal)	Cost-Effective
Dilokthornsakul et al. 2019	Thailand	PCV10-GSK vs. No Vaccination	Dose (3 + 1): 215,948 THB	Not Cost-Effective	None
			Dose (2 + 1): 170,437 THB	Not Cost-Effective
		PCV13-PFE vs. No Vaccination	Dose (3 + 1): 97,269 THB	Cost-Effective
			Dose (2 + 1): 73,674 THB	Cost-Effective
Kulpeng et al. 2013	Thailand	PCV10-GSK vs. No Vaccination	THB 1,368,072 / QALY	Not Cost-Effective	None
		PCV13-PFE vs. No Vaccination	THB 1,490,305 / QALY	Not Cost-Effective
Haasis et al. 2015	Philippines	PCV10-GSK vs. No Vaccination	68,182 Php / QALY (Herd Protection)	Cost-Effective	PCV13-PFE
			112,640 Php / QALY (No Herd Protection)	Cost-Effective
		PCV13-PFE vs. No Vaccination	54,510 Php / QALY (Herd Protection)	Cost-Effective
			84,654 Php / QALY (No Herd Protection)	Cost-Effective
		PCV13-PFE vs. PCV10-GSK	15,795 Php / QALY (Herd Protection)	Cost-Effective
			23,836 Php / QALY (No Herd Protection)	Cost-Effective
Zhang et al. 2014	Philippines	PCV10-GSK vs. No Vaccination	50,913 Php / QALY	Cost-Effective	PCV13-PFE
		PCV10-GSK vs. PCV13-PFE	Dominant	Cost-Effective
Tyo et al. 2011	Singapore	PCV7 vs. No Vaccination	$5,562-43,275 / QALY	Cost-Effective	PCV13-PFE
		PCV10-GSK vs. No Vaccination	$45,100 / QALY	Cost-Effective
		PCV13-PFE vs. No Vaccination	$37,644 / QALY	Cost-Effective
Sundaram et al. 2017	Mongolia	PCV13-PFE vs. No Vaccination	Dominant (Societal)	Cost-Effective	None
			$52 / DALY Averted (Healthcare)	Cost-Effective
Dorji et al. 2018	Bhutan	PCV10-GSK vs. No Vaccination	$36 / QALY	Cost-Effective	None
		PCV13-PFE vs. No Vaccination	$40 / QALY	Cost-Effective
		PCV13-PFE vs. PCV10-GSK	$92 / QALY	Cost-Effective

Vaccine; PCV10= 10-Valent Pneumococcal Conjugate Vaccine; PCV13=13-Valent Pneumococcal Conjugate Vaccine; PFE=Pfizer Inc.; Php= Philippine Peso; PNE=Pneumonia; THB=Thai Bhat; YLL= Years Life Lost; QALY=Quality Adjusted Life-Year

Table 3. Assumptions and Key Results Drivers

STUDY	COUNTRY(S)	SEROTYPE REPLACEMENT	HERD EFFECT	CROSS-PROTECTION	PCV13-PFE EFFECT ON ST3	IMPACT OF PCV10 ON NTHI
Nakamura et al. 2011	Middle-Income Countries	Considered	Considered	Yes (6A/6B)	Not Modified	Not Considered
Tasslimi et al. 2011	Global Analysis	Considered	Considered	Not Considered	Not Modified	Not Considered
Chen et al. 2019	GAVI-Eligible	Considered	Considered	Not Considered	Not Modified	Not Considered
Che et al. 2014	China	Not Considered	Considered	Not Considered	N/R	N/R
Hu et al. 2014	China	Not Considered	Considered	Not Considered	N/R	N/R
Caldwell et al. 2015	China	Not Considered	Considered	Not Considered	N/R	N/R
Maurer et al. 2016	China	Not Considered	Not Considered	Not Considered	Not Modified	Not Considered
Mo et al. 2016	China	Not Considered	Considered	Not Considered	Not Modified	Not Considered
Shen et al. 2018	China	Not Considered	Considered	Not Considered	Not Modified	N/R
Zhou et al. 2018	China	Considered	Considered	Not Considered	Not Modified	N/R
Aljunid et al. 2011	Malaysia	Not Considered	Considered	Not Considered	N/R	N/R
Aljunid et al. 2014	Malaysia	Considered	Considered	Yes (6A 76%; 19A 26%)	Assumed 0%	35% (IPD); 35.6% (AOM)
Wang et al. 2017	Malaysia	Not Considered	Not Considered	Yes (6A 63.7%; 19A 61%)	Reduced to 26%	21.5% (AOM)
Wu et al. 2016	Malaysia, Hong Kong	Considered	Considered	Not Considered	Not Modified	Assumed 0%
Hoshi et al. 2012	Japan	Not Considered	Not Considered	Not Considered	N/R	N/R
Hoshi et al. 2013	Japan	Not Considered	Not Considered	Not Considered	Excluded for AOM in Base Case A; Included in AOM Base Case B	N/R
Shiragami et al. 2015	Japan	Not Considered	Not Considered	Yes (6A 76%; 19A 82.2%)	Assumed 0%	21.5% (AOM)
Lee et al. 2013	Hong Kong	Not Considered	Considered	76.0% Against 6A for PCV10-GSK	Not Modified	35.6% (AOM)
Lee et al. 2009	Hong Kong	Not Considered	Considered	Not Considered	N/R	N/R
Sohn et al. 2010	Korea	Not Considered	Not Considered	Not Considered	N/R	N/R
Zhang et al. 2018	Korea	Not Considered	Not Considered	Yes (6A 76%; 19A 72%)	Reduced to 26%	21.5% (AOM)
Krishnamoorthy et al. 2019	India	Not Considered	Not Considered	Not Considered	Not Modified	N/R
Megiddo et al. 2018	India	Considered	Not Considered	Not Considered	Not Modified	N/R
Wu et al. 2012	Taiwan	Not Considered	Considered	Not Considered	Not Modified	N/R
Wu et al. 2013	Taiwan	Not Considered	Considered	Not Considered	N/R	N/R
Dilokthornsakul et al. 2019	Thailand	Not Considered	Considered	Not Considered	Not Modified	Not Considered
Kulpeng et al. 2013	Thailand	Considered	Considered	Not Considered	Not Modified	Not Considered
Haasis et al. 2015	Philippines	Not Considered	Considered	Not Considered	Not Modified	Assumed 0%
Zhang et al. 2014	Philippines	Considered	Not Considered	Yes (6A 76%; 19A 26%)	Assumed 0%	35.3% (AOM)
Tyo et al. 2011	Singapore	Considered	Considered	Not Considered	Not Modified	0% (AOM)
Sundaram et al. 2017	Mongolia	Considered	Considered	Not Considered	Reduced to 34%	N/R
Dorji et al. 2018	Bhutan	Not Considered	Considered	Not Considered	Not Modified	Not Considered

NOTE: All assumptions are reported for base case analyses and do not include sensitivity or scenario analysis.

Abbreviations: AOM=Acute Otitis Media; GAVI=Gavi, the Vaccine Alliance; GSK=GlaxoSmithKline IPD= Invasive Pneumococcal Disease; N/R = Not Relevant to Study