Modeling the sustained use of the 13-valent pneumococcal conjugate vaccine compared to switching to the 10-valent vaccine in Mexico

Figures & data

Figure 1. Historic cost of PCV program and cost-savings from cases of disease averted (millions of $MXN). summarizes the historic vaccine investment costs and the cost savings from observed reductions in IPD, Pneumonia, OM, and indirect costs between 2006 and 2014 in Mexico.

Results are presented in $MXN ($19.7 MXN = $1 USD)OM = Otitis Media; IPD = invasive pneumococcal disease

Figure 2. Forecasted incidence of invasive pneumococcal disease in 0–2 and 65 year Olds. presents the (A) forecasted all-cause IPD in 0–2 year olds using trend line estimates from Mexico, (B) the incidence of IPD in 0–2 year olds by serotype at the time of switch, and 5 and 10 years post switch with PCV10 or PCV13,(C) the forecasted all-cause IPD in 65+ year olds using trend line estimates from Mexico, (D) and the incidence of IPD in 65+ year olds by serotype at the time of switch, and 5 and 10 years post switch with PCV10 or PCV13.

Table 1. Historic impact of pneumococcal vaccination programs.

Parameter	PCV Program	No PCV Program	Difference
Outcome
Estimated Cases of:
IPD	16,138	23,382	−7,244
OM	6,612,647	7,372,469	−759,822
Nonhospitalized pneumonia	3,052,273	3,777,884	−725,612
Hospitalized pneumonia	436,039	539,698	−103,659
Total cases	10,117,097	11,713,433	−1,596,337
Disease-related deaths	11,661	13,501	−1,840
Costs
Vaccine-related	$15,617,279,631	$0	$15,617,279,631
IPD direct medical	$2,009,753,583	$2,974,119,745	-$964,366,163
Pneumonia direct medical	$139,723,616,475	$172,736,278,355	-$33,012,661,879
OM direct medical	$97,950,395,460	$113,908,778,235	-$15,958,382,775
Indirect (lost productivity)	$872,914,311	$1,037,818,140	-$164,903,829
Total costs	$256,173,959,460	$290,656,994,474	-$34,483,035,014

Results are presented in $MXN ($19.7 MXN = $1 USD)OM = Otitis Media; IPD = invasive pneumococcal disease; PCV = pneumococcal conjugate vaccine

Table 2. Prospective impact of maintaining PCV13 versus switching to PCV10 over 10 years.

Parameter	PCV13 Program	PCV10 Program	Difference
Outcome
Number of cases of:
IPD	16,807	17,247	−440
OM	7,023,033	7,245,033	−222,000
Nonhospitalized pneumonia	3,542,791	3,619,435	−76,644
Hospitalized pneumonia	506,113	517,062	−10,949
Total cases	11,088,743	11,398,777	−310,034
Disease-related deaths	48,795	49,168	−373
QALYs	747,041,374	747,040,067	1,307
Costs
Vaccine-related	$12,941,913,312	$11,325,571,425	$1,616,341,887
IPD direct medical	$1,593,612,279	$1,657,311,997	-$63,699,718
Pneumonia direct medical	$124,389,694,990	$126,775,360,463	-$2,385,665,473
OM direct medical	$68,335,620,605	$74,195,721,482	-$5,860,100,877
Indirect (loss of productivity)	$737,920,604	$755,540,600	-$17,619,996
Total costs	$207,998,761,791	$214,709,505,967	-$6,710,744,176
Incremental cost-effectiveness
Incremental cost per QALY gained			PCV13 Cost-saving

Results are presented in $MXN ($19.7 MXN = $1 USD)OM = Otitis Media; IPD = invasive pneumococcal disease; PCV10 = 10-valent pneumococcal conjugate vaccine; PCV13 = 13-valent pneumococcal conjugate vaccine; QALY = quality-adjusted life-year.

Table 3. Scenario analyses of maintaining PCV13 compared to switching to PCV10.

Parameter	Incremental Cost	Incremental QALYs	ICER
Base case	-$6,710,744,176	1,307	PCV13 Cost-saving
Alternate trend line estimates^a
PCV13 UK/PCV10 Finland	-$15,031,003,157	5,380	PCV13 Cost-saving
PCV13 US/PCV10 Finland	-$35,322,154,172	10,012	PCV13 Cost-saving
PCV13 UK/PCV10 Netherlands	$2,068,788,272	1,371	PCV13 More effective
PCV13 US/PCV10 Netherlands	-$14,104,202,560	4,792	PCV13 Cost-saving
Time horizon
5 Years	-$1,326,122,906	298	PCV13 Cost-saving
20 Years	-$20,847,243,294	4,765	PCV13 Cost-saving
Years until disease re-emergence begins after switch of vaccine^b
2 Years	-$4,873,592,852	1,111	PCV13 Cost-saving
3 Years	-$3,297,027,160	963	PCV13 Cost-saving
Maximum replacement to Pre-PCV levels
75% of pre-PCV incidence	-$6,717,284,575	1,325	PCV13 Cost-saving

Results are presented in $MXN ($19.7 MXN = $1 USD)PCV10 = 10-valent pneumococcal conjugate vaccine; PCV13 = 13-valent pneumococcal conjugate vaccine

^a Alternate trend lines apply trends from each country to serotype distribution in the year of switch in Mexico to estimate sensitivity of potential serotype replacement^bThese scenarios assume that serotype replacement may take several years to occur given sustained use of PCV13 in years before switch.

Table 4. Population and economic parameters.

Parameter (source)	Age range (years)
	0 to < 2	2 to 4	5 to 17	18 to 34	35 to 49	50 to 64	65+
2014 population ^Citation22	4,425,280	6,636,434	29,146,268	33,864,877	23,663,980	14,420,395	8,127,855
% IPD presenting as meningitis ^Citation23	46.8%	37.8%	40.6%	38.8%	50.0%	47.4%	33.3%
Direct costs ($MXN) ^Citation38
Bacteremia	$129,438	$129,317	$69,161	$71,172	$72,663	$77,038	$143,523
Meningitis	$206,173	$205,980	$145,159	$149,379	$152,508	$161,692	$228,609
Hospitalized pneumonia	$52,131	$52,083	$51,803	$53,308	$54,425	$57,702	$57,804
Nonhospitalized pneumonia	$36,707	$36,673	$36,476	$37,536	$38,322	$40,630	$40,702
Otitis media	$60,318	$25,133	$9,048	-	-	-	-
Hours of lost productivity per case^Citation39
Bacteremia	10.00	10.00	10.00	10.00	10.00	10.00	10.00
Meningitis	5.90	5.90	5.90	5.90	5.90	5.90	5.90
Hospitalized pneumonia	7.96	7.96	7.96	7.96	7.96	7.96	7.96
Nonhospitalized pneumonia	7.96	7.96	7.96	7.96	7.96	7.96	7.96
Otitis Media	2.84	2.84	2.84
Age-specific baseline utility ^Citation40	0.94	0.94	0.94	0.93	0.93	0.92	0.91
General mortality
Mortality per 100,000	690.56	44.68	53.12	148.77	321.40	964.52	4,753.06
Case-fatality rates ^Citation31–Citation34
Meningitis	14.7%	14.7%	14.7%	14.7%	14.7%	20.0%	25.3%
Bacteremia	4.5%	3.5%	4.2%	4.1%	4.1%	4.1%	4.1%
Hospitalized pneumonia	3.0%	3.0%	3.0%	3.0%	3.0%	12.4%	16.8%

Results are presented in $MXN ($19.7 MXN = $1 USD)

Table 5. Epidemiologic parameters (per 100,000 population).

Parameter	2006	2007	2008	2009	2010	2011	2012	2013	2014
Invasive pneumococcal disease (age) ^Citation7
< 2	17.04	14.36	11.37	7.58	9.11	8.80	6.50	6.54	7.04
2 to 4	2.02	2.03	1.71	1.23	1.42	1.21	1.00	1.12	0.94
5 to 17	1.90	1.91	1.70	1.42	1.39	1.47	1.37	1.57	1.13
18–34	1.05	1.15	0.93	0.76	1.11	1.18	1.65	1.22	0.91
35–49	0.90	0.93	0.88	0.81	0.79	1.26	1.35	1.27	0.73
50–64	1.73	2.02	1.70	1.30	1.35	1.88	2.17	1.32	1.22
≥ 65	0.79	0.92	0.84	0.68	0.55	0.84	0.76	0.76	0.59
Otitis Media (age) ^Citation7
< 2	1,554.5	1,445.6	1,479.7	1,377.4	1,244.0	1,212.3	940.8	913.0	855.3
2 to 4	1,615.5	1,538.2	1,535.5	1,430.4	1,455.0	1,425.4	1,142.6	1,159.8	1,081.8
5 to 17	2,215.2	2,110.1	2,088.6	2,085.0	2,070.2	2,086.4	1,877.0	1,889.7	1,860.6
Nonhospitalized pneumonia (age)^1
< 2	11,889.2	12,532.0	11,001.1	9,127.5	10,037.4	10,559.1	7,310.8	8,429.3	6,760.8
2 to 4	3,302.7	3,185.4	2,883.0	2,977.9	3,165.7	3,043.3	2,347.5	2,482.0	2,412.3
5 to 17	1,180.4	1,103.6	1,014.1	1,344.2	1,160.0	963.6	922.5	920.1	1,090.1
18–34	433.9	448.7	448.0	665.6	522.3	429.4	482.1	491.9	605.9
35–49	652.4	678.8	697.9	936.0	741.1	598.9	703.7	756.0	968.1
50–64	2,182.5	2,222.1	2,308.5	2,591.6	2,451.2	2,108.4	2,276.0	2,333.6	2,834.3
≥ 65	2,964.9	3,287.3	3,428.3	3,253.1	3,627.6	3,184.4	3,166.0	3,512.3	3,922.1
Hospitalized pneumonia (age) ^Citation7
< 2	1,698.5	1,790.3	1,571.6	1,303.9	1,433.9	1,508.4	1,044.4	1,204.2	965.8
2 to 4	471.8	455.1	411.9	425.4	452.2	434.8	335.4	354.6	344.6
5 to 17	168.6	157.7	144.9	192.0	165.7	137.7	131.8	131.4	155.7
18–34	62.0	64.1	64.0	95.1	74.6	61.3	68.9	70.3	86.6
35–49	93.2	97.0	99.7	133.7	105.9	85.6	100.5	108.0	138.3
50–64	311.8	317.4	329.8	370.2	350.2	301.2	325.1	333.4	404.9
≥ 65	423.6	469.6	489.8	464.7	518.2	454.9	452.3	501.8	560.3

1 Nonhospitalized pneumonia cases were assumed to be proportional to hospitalized pneumonia based on a 7:1 ratio consistent with previous publications⁸

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