Cost-effectiveness of a national immunization program with the 13-valent pneumococcal conjugate vaccine compared with the 10-valent pneumococcal conjugate vaccine in South Korea

Figures & data

Table 1. Epidemiologic inputs used in cost-effectiveness analysis

Parameter	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
Invasive Pneumococcal Disease^Citation26
<2	1.92	1.30	2.26	1.54	2.36	1.53	2.70	1.35	1.61	1.64	1.64
2 to 4	1.18	0.72	0.96	1.57	0.55	0.84	1.50	0.55	0.75	0.94	0.94
5 to 17	0.28	0.36	0.35	0.43	0.34	0.30	0.33	0.24	0.28	0.38	0.38
18–34	0.42	0.40	0.41	0.37	0.35	0.32	0.42	0.33	0.48	0.39	0.39
35–49	0.42	0.40	0.41	0.37	0.35	0.32	0.42	0.33	0.48	0.39	0.39
50–64	1.11	0.89	1.02	0.92	0.96	0.98	0.83	0.95	0.87	0.80	0.80
≥65	2.24	2.66	3.17	3.20	2.70	2.00	2.61	2.66	2.48	2.33	2.33
Acute Otitis Media (age)*^Citation12
0 to <2	57,785	57,785	57,785	57,785	57,785	57,785	57,785	53,162	48,909	44,996	41,397
2 to 4	80,011	80,011	80,011	80,011	80,011	80,011	80,011	73,610	67,722	62,304	57,320
Hospitalized Pneumococcal Pneumonia (age)^Citation26
<2	201	123	100	71	63	54	59	50	45	63	63
2 to 4	306	276	190	115	105	101	110	90	64	100	100
5 to 17	70	72	39	37	53	45	42	30	22	26	26
18–34	17	21	10	12	21	19	15	10	10	12	12
35–49	21	21	13	13	14	14	12	11	9	13	13
50–64	27	27	21	21	19	15	14	12	9	15	15
≥65	53	52	43	43	42	22	23	18	15	19	19

*AOM incidence rates were reduced by 40.6% based on observed effectiveness in the US to account for sustained PCV use in lieu of available post PCV incidence of AOM in Korea.

Table 2. Cost, utility and case fatality parameters used in cost-effectiveness analysis

	Age range (years)
Parameter	<2	2 to 4	5 to 17	18–34	35–49	50–64	≥ 65
Population
Percentage of IPD presenting as meningitis^Citation5,Citation32	47.8%	27.1%	48.0%	16.3%	16.3%	6.6%	6.4%
Direct costs (USD$)^Citation37
Bacteremia	$3515.00	$3515.00	$3515.00	$3515.00	$3515.00	$3515.00	$3515.00
Meningitis	$3681.00	$3681.00	$3681.00	$3681.00	$3681.00	$3681.00	$3681.00
Hospitalized pneumonia	$1730.00	$1730.00	$1730.00	$1730.00	$1730.00	$1730.00	$1730.00
Acute otitis media	$60.00	$60.00
Case-fatality rates^Citation26,Citation32,Citation35
Bacteremia	5.6%	5.6%	5.6%	18.4%	18.4%	26.9%	40.7%
Meningitis	15.6%	11.6%	6.4%	18.4%	18.4%	26.9%	40.7%
Hospitalized pneumonia	0.1%	0.1%	0.1%	7.0%	7.0%	7.0%	7.0%

Figure 1. Incidence of IPD today and in 5 and 10 years from now given a PCV10 and PCV13 vaccination policy in individuals aged 0 to 2 years and ≥65 years

Figure 1 presents the impact of an infant vaccination program with PCV10 and PCV13 in individuals aged 0 to 2 years (Figure 1a) and those 65+ (Figure 1b) in Korea at the time of switch and over the next 5 and 10 years. PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.

Table 3. Prospective impact of a PCV13 or PCV10 NIP over 5 years

Parameter	PCV13 Program	PCV10 Program	Incremental
Outcome
Number of cases of:
IPD	2370	2956	−586
Pneumococcal AOM	2,602,436	3,107,409	−504,973
Hospitalized pneumococcal pneumonia	56,365	107,186	−50,821
Total cases	2,661,171	3,217,551	−556,379
Deaths	3183	5309	−2126
QALYs	184,212,041	184,205,503	6537
Costs
Vaccine-related	$396,227,238	$339,622,828	$56,604,411
IPD direct medical	$7,210,119	$9,013,219	−$1,803,099
Pneumonia direct medical	$83,973,075	$159,232,950	−$75,259,875
AOM direct medical	$134,625,456	$161,586,490	−$26,961,034
Total costs	$622,035,889	$669,455,487	−$47,419,598
Incremental cost-effectiveness
			PCV13 Cost-Saving

AOM, acute otitis media; IPD, invasive pneumococcal disease; PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; QALY, quality-adjusted life-year.

Table 4. Scenario analyses of a PCV13 NIP compared with a PCV10 NIP in South Korea

Parameter	Incremental cost	Incremental QALYs	ICER
Base Case	−$47,419,598	6537	PCV13 Cost-Saving
Trend Line Analysis
PCV13 South Korea/PCV10 Netherlands	−$14,901,478	4660	PCV13 Cost-Saving
PCV13 US/PCV10 Finland	−$78,809,117	9174	PCV13 Cost-Saving
PCV13 US/PCV10 Netherlands	−$46,290,996	7296	PCV13 Cost-Saving
PCV13 UK/PCV10 Finland	−$6,433,955	3593	PCV13 Cost-Saving
PCV13 UK/PCV10 Netherlands	$26,084,165	1715	$15,210/QALY
Time Horizon
10 Years	−$25,277,949	13,713	PCV13 Cost-Saving
20 Years	−$14,086,452	26,352	PCV13 Cost-Saving
Lag in serotype divergence
1 Years	−$1,570,895	4249	PCV13 Cost-Saving
2 Years	$18,366,678	7374	$7,373 USD/QALY
Varying Percent AOM cases caused by S. pneumoniae
25%	−$245,964	4459	PCV13 Cost-Saving
50%	−$63,584,114	9918	PCV13 Cost-Saving
IPD, invasive pneumococcal disease; AOM, acute otitis media; QALY, quality-adjusted life-years.

^aAlternate trend lines apply trends from each country to serotype distribution in the year of switch in Mexico to estimate sensitivity of potential serotype replacement

Figure 2. One-way sensitivity analysis: PCV13 versus PCV10 incremental cost per quality-adjusted life-year

Figure 2 presents the results of the one-way sensitivity analysis for PCV13 versus PCV10. Red-shaded bars represent the incremental cost-effectiveness ratio at the upper bound of the input parameter estimate, and blue-shaded bars represent the incremental cost-effectiveness ratio at the lower bound of the parameter estimate.

Figure 3. Probabilistic sensitivity analysis for Base Case Analysis

Figure 3 presents the results of a first-order Monte Carlo simulation with 1000 simulations. Gray dots represent the incremental cost and QALY results for each of 10,000 iterations of the simulation. The blue square represents the base case incremental cost and QALY estimate. ICER, incremental cost-effectiveness ratio; QALYs, quality-adjusted life-years.

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