Estimating the population health and economic impacts of introducing a pneumococcal conjugate vaccine in Malaysia- an economic evaluation

Figures & data

Table 1. Epidemiological and cost inputs used in the cost-effectiveness of infant pneumococcal vaccination program.

	Age range (years)
Input	0<2	2-4		5-17	18-34	35-49	50-64	≥65	Source
Population	1,072,087	1,540,160		6,737,721	10,201,683	5,838,851	3,901,771	1,894,991	The World Bank
Disease Rates (per 100,000 person-years)
Invasive pneumococcal disease (IPD)	45	45		7.2	7.56	7.97	16.9	48.2	Wahl et al.^Citation3
Pneumococcal bacteremia
Incidence (per 100,000 person-years)	29.25	39.6		6.48	6.88	7.25	15.72	47.2	Wahl et al.^Citation3
Case fatality rate (CFR)	23.0%	23.0%		23. 0%	13.1%	13.1%	13.1%	13.1%	Wu et al.^Citation10
Pneumococcal meningitis
Incidence (per 100,000 person-years)	15.75	5.4		0.72	0.68	0.71	1.18	0.96	Wahl et al.^Citation3
Case fatality rate (CFR)	33.0%	33.0%		10.0%	10.0%	11.0%	11.4%	23.8%	Wu et al.^Citation10
Hearing loss, probability of (%)	13%								Wu et al.^Citation10
Neurological sequelae, probability of (%)	7%								Wu et al.^Citation10
Inpatient pneumococcal pneumonia
Incidence (per 100,000 person-years)	45.5	45.5		35.2	13.3	24.1	55.7	215.7	Wahl et al.^Citation3
Case fatality rate (CFR)	4.0%	4.0%		0.3%	0.7%	1.7%	2.5%	6.3%	Wu et al.^Citation10
Outpatient pneumococcal pneumonia
Incidence (per 100,000 person-years)	709	709		54.9	20.8	37.6	86.7	336.1	Wahl et al.^Citation3
Simple AOM
Incidence (per 100,000 person-years)	19,786	22,149		5,696	-	-	-	-	Wahl et al.^Citation3
Direct Medical Costs ($ USD)
Vaccine cost per dose (PCV10/PCV13)	Price disparity between PCV13 and PCV10 assumed to be 40%
Pneumococcal bacteremia	9,194		9,194	9,194	7,980	7,980	7,980	7,980	Aljunid et al.^Citation9
Pneumococcal meningitis	7,015		7,015	7,015	4,553	4,553	4,553	4,553	Aljunid et al.^Citation9
Pneumonia inpatient	3,367		3,367	3,367	3,678	3,678	3,678	3,678	Aljunid et al.^Citation9
Pneumonia outpatient	556		556	556	556	556	556	556	Ahmed et al.^Citation23
Simple AOM	556		556	-	-	-	-	-	Ahmed et al.^Citation23
Severe AOM	3,319		3,319	-	-	-	-	-	Aljunid et al.^Citation9
Indirect Costs ($ USD))
Pneumococcal bacteremia	596		596	596	648	648	648	648	Wu et al.^Citation10
Pneumococcal meningitis	999		999	999	648	648	648	648	Wu et al.^Citation10
Pneumonia inpatient	807		807	807	95	95	95	95	Wu et al.^Citation10
Pneumonia outpatient	224		224	224	648	648	648	648	Wu et al.^Citation10
Simple AOM	595		595	-	-	-	-	-	Wu et al.^Citation10
Severe AOM	595		595	-	-	-	-	-	Wu et al.^Citation10

All costs are expressed in 2018 USD

PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13 valent pneumococcal conjugate vaccine; AOM, Acute Otitis Media

Figure 1. Forecasted incidence trend based on historical invasive pneumococcal disease rates in 0–2 year olds.

Figure 2. Forecasted incidence trend based on historical invasive pneumococcal disease rates in >65 year olds.

Table 2. Incremental cases, deaths, and costs under a PCV13 versus PCV10 vaccination program, over a 5- year time horizon.

	Malaysia
	PCV13	PCV10	Incremental
Cases
IPD	14,517	18,603	−4,086
AOM	1,199,088	1,359,921	−160,833
Pneumonia	242,432	268,141	−25,708
		Total cases avoided	−190,628
Mortality Avoided
IPD	2,362	3,086	−724
Pneumonia	3,339	3,741	−402
		Total mortality avoided	−1126
Outcomes
QALYs Gained	127,758,988	127,756,708	2,280
Costs, USD
Vaccine acquisition	331,881,061	241,976,285	89,904,777
Direct medical care
IPD	110,116,905	140,567,529	−30,450,624
AOM	614,698,389	695,960,109	−81,261,720
Pneumonia	383,623,094	422,316,542	−38,693,448
Indirect (Productivity loss)	762,940,690	862,754,820	−99,814,122
		Net cost	−160,315,137
Incremental Cost-Effectiveness
Cost per QALY			PCV13 Cost Saving

PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13 valent pneumococcal conjugate vaccine; IPD, Invasive Pneumococcal Disease; AOM, Acute Otitis Media; QALY, Quality- adjusted life year

Figure 3. Annual incremental costs of PCV13 vs. PCV10 vaccination program.

Table 3. Incremental cases, deaths, and costs under a PCV13 versus no vaccination program, over a 5- year time horizon.

	Malaysia
	PCV13	No vaccination	Incremental
Cases
IPD	14,517	24,535	−10,018
AOM	1,119,088	1,724,054	−524,966
Pneumonia	242,432	323,875	−81,443
		Total cases avoided	−616,427
Mortality Avoided
IPD	2,362	4,135	−1,773
Pneumonia	3,339	4,613	−1,273
		Total mortality avoided	−3,046
Outcomes
QALYs Gained	127,758,988	127,752,980	6,008
Costs, USD
Vaccine acquisition	331,881,061	0	331,881,061
Direct medical care
IPD	110,116,905	184,686,008	−74,569,103
AOM	614,698,389	878,270,484	−263,572,095
Pneumonia	383,623,094	505,317,442	−121,694,349
Indirect (Productivity loss)	762,940,698	1,083,368,941	−320,428,243
		Net cost	−448,382,729
Incremental Cost-Effectiveness
Cost per QALY			PCV13 Cost Saving

PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13 valent pneumococcal conjugate vaccine; IPD, Invasive Pneumococcal Disease; AOM, Acute Otitis Media; QALY, Quality- adjusted life year

Figure 4. Annual incremental costs of PCV13 vs. no vaccination program.

Table 4. Sensitivity analyses and the incremental costs and quality-adjusted life years (QALY) under a PCV13 versus PCV10 vaccination program.

	PCV13		PCV10		Incremental
Analysis	Cost, USD	QALYs	Cost, USD	QALYs	Cost, USD	QALYs
Base case	2,203,260,147	127,758,988	2,363,575,284	127,756,708	−160,315,137	2,280
Payer perspective	1,440,319,449	127,758,988	1,500,820,465	127,756,708	−60,501,015	2,280
Indirect effects of pneumonia included (both vaccines)	2,120,247,777	127,760,356	2,318,525,065	127,757,617	−198,277,289	2,739
Impact on AOM due to NTHi included (both vaccines)	2,291,786,155	127,757,073	2,465,047,494	127,754,513	−173,261,339	2,560
Impact on AOM due to NTHi included (PCV13 only)	2,291,786,155	127,757,073	2,551,504,735	127,752,643	−259,718,580	4,430
Ten-year time horizon	4,031,292,097	232,460,670	4,694,411,404	232,448,593	−663,119,307	12,077
Netherlands PCV10 trend line	2,203,260,147	127,758,988	2,376,000,591	127,756,702	−172,740,444	2,286
Epidemiological Inputs from Wu et al.^Citation10*	2,300,891,395	127,762,181	2,381,284,654	127,761,243	−80,393,259	938

*This sensitivity analysis was conducted using epidemiological inputs from Wu et al.¹⁰ as shown in Supplementary Tables 1 and 2.

PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13 valent pneumococcal conjugate vaccine; AOM, Acute Otitis Media; NTHi, non- typeable Haemophilus Influenza

Wahl B, O’Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, Luksic I, Nair H, McAllister DA, Campbell H, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Health. 2018;6(7):e744–e57. doi:10.1016/S2214-109X(18)30247-X.

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