Economic studies applied to vaccines against invasive diseases: An updated budget impact analysis of age-based pneumococcal vaccination strategies in the elderly in Italy

Figures & data

Table 1. Avoided cases and deaths following PCV13 vaccination versus the no-vaccination scenario in the elderly population over the 5-year immunization period.

Vaccination strategies	1 cohort/year (65 years)	2 cohorts/year (65 and 70 years)	3 cohorts/year (65, 70 and 75 years)
Pneumococcal cases avoided
Hospitalised NB CAP due to Sp	729	1,380	1,989
Non-hospitalised NB CAP due to Sp	1,564	2,960	4,266
B CAP due to Sp	900	1,703	2,454
PM	58	109	163
Total avoided cases	3,250	6,152	8,872
Deaths avoided
NB CAP due to Sp	138	260	375
B CAP due to Sp	83	157	251
Pneumococcal meningitidis deaths	11	20	36
Total avoided deaths	231	437	663

Table 2. Economic savings due to avoided cases, vaccination costs, net costs, net costs per immunised cohort, QALYs and ICERs related to PCV13 vaccination of the elderly population over the 5-year immunisation period in Italy (Euro).

Vaccination strategies	1 cohort/year (65 years)	2 cohorts/year (65 and 70 years)	3 cohorts/year (65, 70 and 75 years)
Total economic savings due to avoided cases	6,363,255	12,030,322	17,263,909
– Hospitalised NB CAP due to Sp	1,808,459	3,419,040	4,929,453
– Non-hospitalised NB CAP due to Sp	151,909	287,196	414,069
– B CAP due to Sp	3,385,723	6,401,054	9,228,729
– PM	1,017,164	1,923,032	2,691,659
Vaccination costs	85,030,469	164,511,043	233,969,179
Vaccination net costs	78,667,214	152,480,722	216,705,270
Vaccination net costs/ n° vaccinated cohorts	15,733,443	15,248,072	14,447,018
QALY	5,386	9,901	14,061
Costs / QALY	14,605	15,401	15,412

Table 3. Pneumococcal cases and deaths avoided, economic savings due to avoided cases, vaccination costs, net costs, QALY and ICERs related to the comparative single-cohort PCV13 vaccination strategies (Euro).

Vaccination strategies
Single cohort/year	65 years	70 years	75 years
Pneumococcal cases avoided	3,250	2,901	2,720
Deaths avoided	231	206	225
Total economic savings due to avoided cases	6,363,255	5,667,067	5,233,659
Vaccination costs	85,030,469	79,480,574	69,458,136
Vaccination net costs	78,667,214	73,813,508	64,224,477
Vaccination net costs/ n° vaccinated cohorts	15,733,443	7,381,351	4,281,632
QALY	5,386	4,514	4,160
Cost / QALY	14,605	16,351	15,438

Table 4. Cost (Euro) per QALY in the sensitivity analysis.

Vaccination strategy	1 cohort/year (65 years)	2 cohorts/year (65 and 70 years)	3 cohorts/year (65, 70 and 75 years)
Univariate sensitivity analysis: cost/QALY
CAP due to S. pneumonia: 24.3%	24,283	25,590	25,608
−10% CAP and PM incidence	16,359	17,247	17,261
Vaccinated by GP: 50%	15,122	15,946	15,878
Base case scenario	14,605	15,401	15,412
PCV13 vaccination coverage: 50%	14,605	15,401	15,412
Hospitalised CAP cost: €3,286.82/case	14,529	15,323	15,333
Vaccine delivery cost/dose: 65–74 years: €2; >74 years: €1	14,267	15,046	15,108
Multivariate sensitivity analysis: cost/QALY
Worst case scenario:
• CAP due to S. pneumonia: 24.3%
• −10% CAP and PM incidence
• Vaccinated by GP: 50%	28,055	29,561	29,439
Base case scenario	14,605	15,401	15,412
Best case scenario:
• PCV13 vaccination coverage: 50%
• Hospitalised CAP cost: €3,286.82/case
• Vaccine delivery cost/dose: 65–74 years: €2; > 74 years: €1	14,191	14,968	15,029

Table 5. Input data in the population model (base case scenario).

CLINICAL DATA	Values	Sources
CAP incidence >64 y (per 1,000)	3.34	Viegi, 2006^19
CAP hospitalisation rate (%)	31.8	Viegi, 2006^19
CAP case fatality rate (%)	6.0	Viegi, 2006^19
CAP due to S.pneumonae (%)	39.8	Bewick, 2012^20
Bacteraemiac CAP (%)	20	Said, 2013^15
PM Incidence (per 100,000)	65–74 years: 1.7	Merito, 2007^21
	75–84 years: 1.9
	> 84 years: 0.8
PM case fatality rate (%)	65–74 years: 18.5	Merito, 2007^21
	75–84 years: 29.4
	> 84 years: 39.4
VACCINATION DATA
PCV13 vaccination coverage (%)	60	as flu vaccination
PCV13 serotype coverage against pneumonia (%)	73.5	Schito, 2011^22
PCV13 serotype coverage against IPD (%)	69.2	Schito, 2011^22
PCV13 effectiveness against pneumonia (%)	75.0	Bonten, 2015^14
PCV13 effectiveness against PM (%)	45.0	Bonten, 2015^14
COST DATA (Euro)
Cost and benefit discount rate (%)	3
Hospitalised CAP cost/case	2,680.85	Age.na.s. website^23
Non-hospitalised CAP cost/case	105	Potena, 2008^24
BPP cost/ case	4,068.40	Age.na.s. website^23
PM cost/case	65–74 years: 19,114.99	Merito, 2007^21
	>74 years: 15,474.08
PCV13 vaccine cost/dose	42.50
Vaccine delivery cost by general practitioner	65–74 years: 5.76	Merito, 2007^21
	> 74 years: 2.88
Subjects vaccinated with PCV13 by general practitioner (%)	25	Assumption
Weights of quality-adjusted life-years
Average age-specific quality of life:	65–70 years: 0.76	Sisk, 2003^25
	70–75 years: 0.74
	75–80 years: 0.70
	80–85 years: 0.63
IPD	0.2	Smith, 2012^26
		n° hospitalisation days: 34
		Total weights: 0.02
CAP	0.2	Smith, 2012^26
		n° hospitalisation days: 11
		Total weights: 0.01

Figure 1. Cumulative net costs (Euro) per QALY in the analysis period.

Figure 2. Decisional tree in the population model (NB CAP: non-bacteraemic CAP; B CAP: bacteraemic CAP).

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