Cost-effectiveness of the 13-valent pneumococcal conjugate vaccine in adults in Portugal versus “no vaccination” and versus vaccination with the 23-valent pneumococcal polysaccharide vaccine

Figures & data

Table 1. Results of base-case scenario.

	PCV13	No vaccine	PPSV23
Overall number of PD episodes over the lifetime horizon in the population
Bacteremia or sepsis infections	29,728	32,200	30,389
Meningitis infections	6,471	7,131	6,642
Inpatient pneumonia	2,372,771	2,396,994	2,397,043
Outpatient pneumonia	3,203,157	3,252,062	3,252,130
Deaths for PD	641,565	647,277	647,162
Outcomes and costs per capita
LY	15.206	15.202	15.202
QALY	12.048	12.045	12.045
Costs (€)	407.03	360.38	373.92
Cost-effectiveness and costs-utility ratios
ICER
PCV13 vs. no vaccine	11,082 €/LYG
PCV13 vs. PPSV23	8,151 €/LYG
ICUR
PCV13 vs. no vaccine	17,746 €/QALY
PCV13 vs. PPSV23	13,146 €/QALY

LY = Life-years; LYG = Life-year gained; QALY = Quality-adjusted life-years; ICER = Incremental cost-effectiveness ratio; ICUR = incremental cost-utility ratio.

Table 2. Results of univariate sensitivity analyses.

		PCV13 vs. PPSV23		PCV13 vs. no vaccination
Scenario		ICER (€/LYG)	ICUR (€/QALY)	ICER (€/LYG)	ICUR (€/QALY)
Base-case		8,151	13,146	11,082	17,746
No indirect costs		8,420	13,580	11,380	18,224
Inclusion of travel costs^a	50% incurs in travel costs	8,151	13,146	11,570	18,526
Discount rate	0%	4,214	6,803	5,764	9,234
	3%	6,429	10,374	8,766	14,041
Herd effect	No herd effect	8,045	12,974	10,802	17,270
	+50%	8,204	13,233	11,226	17,991
Immunization rate^b	50.1% (≥65 years) 5.0% (<65 years)	2,590	4,408	3,931	6,675
Inpatient CAP incidence	−20%	10,476	16,904	13,937	22,292
	+20%	6,591	10,620	9,142	14,641
Outpatient CAP incidence	−20%	8,409	13,648	11,331	18,254
	+20%	8,086	13,022	11,020	17,620
Effectiveness of PCV13	−50%	18,650	30,096	23,570	37,515
	+50%	2,825	4,556	4,416	7,095

CAP = Community-acquired pneumonia; LYG = Life-Year-Gained; QALY = Quality-adjusted life years; ICER = Incremental cost-effectiveness ratio; ICUR = incremental cost-utility ratio. ^aUnit cost for non-urgent transportation to Primary Care was recently estimated for Portugal at 4.10€ (two ways).¹⁸ We assumed 50% of users have a contact with the system only because of vaccination. ^bUptake rates of vaccination similar to the immunization rate reported in Portugal in 2015–2016 for Influenza vaccination.¹⁹

Figure 1. Economic model.

IPD: invasive pneumococcal disease. CAP: Community Acquired PneumoniaAll transition probabilities vary with age, risk profile (low, moderate or high) and time since vaccination.

Table 3. Demographic and epidemiological parameters.

Portugal population, by age and risk group^a
Age group	Population	Low risk	Moderate risk	High risk
18–49	4,080,167	88.9%	8.6%	2.4%
50–64	1,987,704	72.4%	21.6%	6.0%
65–74	1,017,870	62.1%	30.6%	7.3%
75–84	734,643	57.3%	33.2%	9.5%
> 84	246,150	62.2%	28.3%	9.5%
Total	8,066,534	63.6%	14.2%	3.5%
Annual incidence of invasive pneumococcal diseases and all-cause pneumonia per 100,000 persons assuming no vaccination^b
Age group	Bacteremia and sepsis	Meningitis	Pneumonia inpatient	Pneumonia outpatient
18–49	3.49	1.02	53.87	315.76
50–64	8.51	2.92	199.68	754.21
65–74	11.07	3.47	548.20	1,325.38
75–84	21.32	5.04	1,780.73	2,449.95
> 84	54.47	5.28	5,243.96	3,349.64
Total	8.86	2.29	467.84	838.16
Mortality rates for the general population and fatality rates of IPD and pneumonia^c
Age group	General population adjusted mortality	Bacteremia and sepsis	Meninigits	Pneumonia (inpatient)
18–49	0.08%	4.26%	6.0%	5.37%
50–64	0.37%	3.80%	6.0%	11.04%
65–74	1.12%	2.79%	6.0%	16.81%
75–84	3.48%	7.65%	6.0%	22.44%
> 84	15.19%	7.40%	6.0%	30.82%
Total	1.05%	4.37%	6.0%	10.54%
Health-state utility and yearly disutilities^d
Age group	General population	Bacteriemia and sepsis	Meningitis	Pneumonia inpatient	Pneumonia outpatient
18–49	0.90	0.0079	0.0232	0.0060	0.0040
50–64	0.80	0.0079	0.0232	0.0060	0.0040
65–74	0.74	0.0079	0.0232	0.0060	0.0040
75–84	0.66	0.0079	0.0232	0.0060	0.0040
>84	0.53	0.0079	0.0232	0.0060	0.0040

^aINE 2014,⁵⁰ NHS 2005/2006⁵¹ and INSA 2013⁵², INSA 2014⁵³ and authors’ estimations. ^bDRG 2013⁵⁵ and Prof. Dr. Melo Cristino, 2013. ^cINE 2013,⁵⁷ INE 2014,⁵⁸ DRG 2013⁵⁵ and authors’ estimations. ^dSisk et al. 2003,⁵⁹ and Melegaro and Edmunds 2004.⁶⁰

Table 4. Direct and indirect costs per episode by age and disease (including inpatient and outpatient costs of inpatient follow-up).

Age group	Bacteremia and sepsis	Meningitis	Pneumonia inpatient	Pneumonia outpatient
Direct medical costs
18–49	11,268.24 €	7,880.74 €	4,053.24€	136.92 €
50–64	5,532.87 €	7,880.74 €	3,959.52€	136.92 €
65–74	6,669.53 €	7,880.74 €	2,991.39€	136.92 €
75–84	5,221.06 €	7,880.74 €	2,882.72 €	136.92 €
> 84	4,808.52 €	7,880.74 €	2,515.02 €	136.92 €
Indirect costs
18–49	1,288.78 €	795.64 €	674.96 €	244.55 €
50–64	1,260.45 €	938.72 €	731.96 €	239.47 €
65–74	138.62 €	163.87 €	137.24 €	41.80 €
75–84	0.00 €	0.00 €	0.00 €	0.00 €
> 84	0.00 €	0.00 €	0.00 €	0.00 €

Source: Experts’ opinion, DRG 2013⁵⁵ and order no. 20/2014.

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