Cost-effectiveness analysis of routine 13-valent pneumococcal conjugate vaccinations in Chinese infants

Figures & data

Figure 1. The structure of the model used to assess the health and economic impact of PCV-13 vaccination and possible subsequent events for each child compared to ‘no vaccination’. The following health states are included: meningitis, bacteremia, pneumonia, AOM and no infection.

Table 1. Key inputs of the model.

Parameters	Expected value	Ranges	Source
Clinical data
S. pneumoniae isolation rate for pneumonia	8.0%	2.0%—26.8%	^2
S. pneumoniae isolation rate for AOM	39.2%	29.2%—49.0%	^27
Serotype coverage rates of PCV-13		—
IPD	91.0%	68.3%—100.0%	^20-22
CAP	84.2%	79.6%—86.9%	^20-22
AOM	71.5%	67.6%—73.8%	Estimated
Efficacy of PCV-13		—
IPD	97.4%	73.1%—100.0%	^23^,^24
CAP	39.2%	67.5%—100.0%	^23^,^24
AOM	69.9%	29.8%—87.1%	^23^,^24
Herd effects of PCV-13 for IPD	38.3%	0.0%—38.3%	^18^,^23
Cost data ($)
Bacteremia per event in children	3,256	1,367—5,719	^10
Meningitis per event in children	4,250	1,907—9,572	^10
Pneumonia per hospitalized event	632	443—833	^10
Pneumonia per outpatient event	30	29—32	^10
AOM per simple event	14	11—21	^10
AOM per complex event	23	23—24	^10
Tympanostomy caused by AOM	309	232—386	^10
Bacteremia per event in adult	2,782	2,087—3,478	^10
Meningitis per event in adult	3,897	2,923—4,871	^10
PCV-13 per course	235	176—471	Local charge
Daily average employment costs	23	7—35	Local charge
Disutility weights^*
Bacteremia	0.0079	0.0060—0.0099	^28-30
Meningitis	0.0232	0.0174—0.029	^28-30
Pneumonia	0.0079	0.0060—0.0099	^28-30
AOM	0.0050	0.0036—0.0063	^28-30
Tympanostomy caused by AOM	0.1800	0.1350—0.2250	^28-30
Long-term disability	0.4000	0.3000—0.5000	^28-30
Long-term deafness	0.2000	0.1500—0.2500	^28-30

CAP: community-acquired pneumonia; AOM: acute otitis media; IPD: invasive pneumococcal disease.

* The disutility weight is the lost utility due to disease. The utility value can be calculated by the formula: 1—disutility weight.

Table 2. Projected base-case health outcomes and costs.

	No Vaccination	PCV-13 Vaccination	Differences
Health outcomes
No herd protection
Probability of IPD	0.248%	0.203%	−0.045%
Mortality associated with S. pneumonia	0.003%	0.002%	−0.001%
Discount QALY	19.669	19.678	0.009
Expected LY	73.844	73.854	0.009
Herd protection
Probability of IPD	11.765%	11.682%	−0.083%
Mortality associated with S. pneumonia	0.318%	0.316%	−0.002%
Discount QALY	1,173.497	1,173.508	0.010
Expected LY	2,957.405	2,957.419	0.013
Economic outcomes
No herd protection
Discount cost ($) from the perspective of heath care	138	327	189
ICER ($/QALY) from the perspective of heath care	—	20,709	—
Discount cost ($) from the perspective of society	478	646	169
ICER ($/QALY) from the perspective of society	—	18,483	—
Herd protection
Discount cost ($) from the perspective of heath care	4,485	4,673	188
ICER ($/QALY) from the perspective of heath care	—	18,189	—
Discount cost ($) from the perspective of society	10,127	10,293	166
ICER ($/QALY) from the perspective of society	—	16,106	—

Figure 2. A tornado diagram for PCV13 with herd protection versus no vaccinations from a societal perspective. AOM, acute otitis media; Sp, Streptococcus pneumonia; PCV-13, 13-valent pneumococcal conjugate vaccine.

Figure 3. Cost-effectiveness acceptability curves for PCV-13 and no vaccination in the perspectives of health care and society.

Appendix Table 1. Chinese epidemiological data associated with pneumococcal disease 1.

Pneumococcal Disease	0 – 2 year	3 – 5 year	5 – 17 year	18 – 34 year	35 – 49 year	50 – 64 year	over 65 year
CAP
Annual incidence (per 10,0000)	17695(5013 – 30377)	23082.5(2174 – 43991)	7229.5(227 – 14232)	1309(109 – 2509)	605.5(159 – 1052)	1139(159 – 2119)	5325(2165 – 8485)
Proportion of hospitalization	0.072(0.034 – 0.109)	0.064(0.019 – 0.109)	0.029(0.013 – 0.045)	0.088(0.01 – 0.166)	0.172(0.027 – 0.317)	0.214(0.05 – 0.378)	0.377(0.084 – 0.67)
Case-fatality of hospitalized CAP	0.021(0.002 – 0.04)	0.021(0.002 – 0.04)	0.003(0.002 – 0.003)	0.004(0.001 – 0.007)	0.025(0.017 – 0.032)	0.031(0.025 – 0.037)	0.058(0.052 – 0.063)
IPD
Annual incidence (per 10,0000)	13.9(9.8 – 18)	14.2(12.8 – 15.6)	1.1(1 – 1.2)	1.1(1 – 1.2)	1.1(1 – 1.2)	1.1(1 – 1.2)	10(9.8 – 10.2)
Proportion of meningitis in IPD	0.28(0.21 – 0.35)	0.12(0.09 – 0.15)	0.33(0.25 – 0.42)	0.18(0.14 – 0.23)	0.1(0.08 – 0.13)	0.09(0.07 – 0.11)	0.02(0.02 – 0.03)
Case-fatality of meningitis	0.19(0.05 – 0.33)	0.19(0.05 – 0.33)	0.07(0.05 – 0.1)	0.14(0.1 – 0.18)	0.14(0.11 – 0.18)	0.14(0.11 – 0.18)	0.29(0.24 – 0.35)
Case-fatality of bacteremia	0.14(0.05 – 0.23)	0.14(0.05 – 0.23)	0.14(0.05 – 0.23)	0.15(0.13 – 0.18)	0.15(0.13 – 0.18)	0.15(0.13 – 0.18)	0.24(0.13 – 0.35)
AOM
Annual incidence(per 10,0000)	19707(16930 – 22485)	15488(14355 – 16620)	—	—	—	—	—
Complex AOM	0.104(0.104 – 0.104)	0.11(0.11 – 0.11)	—	—	—	—	—
CAP: community-acquired pneumonia; AOM: acute otitis media; IPD: invasive pneumococcal disease.

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