Recommendations and Health Technology Assessment (HTA) landscape evaluation for pediatric pneumococcal conjugate vaccines (PCV) in Europe: A systematic literature review

Figures & data

Table 1. Data collection table.

Feature	Variable
General information	• HTA/NITAG agency • Year • Report Title • Country • Population • Recommendation: • Taking a stance (positive/negative) either in relation to the implementation of a PCV into the countries NIP, the change of one PCV to another in an existing NIP, or the change in vaccination schedule for an already implemented PCV NIP • No recommendation; neutral assessment
Epidemiological data for IPD, AOM and pneumonia	• Epidemiological context (type of PCV, year of introduction etc.) Inclusion of evidence on: • Incidence • Prevalence • Mortality • Clinical presentation (for IPD, pneumonia) • Serotype distribution • % attributable to S. pneumoniae
Health economic data	• Description of health economic models • Description of major assumptions in model • Model inputs for costs, utilities, epidemiologic, resource use, etc. • Outcomes presented • Conclusion
Other	• HTA/NITAG critiques of evidence

Figure 1. PRISMA flow chart.

Figure 2. Number of records included by country and authoring institution.

Table 2. Overview of evidence included in each record, by country.

Country	Year	PCV	Recommendation	Epidemiological evidence			HE-evidence	Ref
				IPD	AOM	Pneumonia
Austria	2020	PCV13	Positive	x				^Citation27
Belgium	2018	PCV10, PCV13	Positive	x	x	x		^Citation28
Belgium	2011	PCV10, PCV13	N/A	x	x	x	x	^Citation29
Belgium	2006	PCV7	N/A	x	x	x	x	^Citation30
Croatia	2015	PCV10, PCV13	N/A	x	x	x	x	^Citation31
Denmark	2007	PCV7	Positive	x	x		x	^Citation32
Estonia	2015	PCV10, PCV13	N/A	x	x	x	x	^Citation33
Finland	2018	PCV10, PCV13	N/A	x		x	x	^Citation34
Finland	2008	PCV7	Positive	x	x	x	x	^Citation35
France	2018	PCV10	Negative	x	x	x		^Citation24
France	2012	PCV10, PCV13	Negative (PCV10) Positive (PCV13)	x				^Citation23
France	2009	PCV13	Positive	x				^Citation36
France	2008	PCV7	Positive		x	x		^Citation37
France	2006	PCV7	Positive	x	x			^Citation38
Germany	2015	PCV10, PCV13	Positive	x				^Citation39
Germany	2008	PCV7	N/A	x	x	x	x	^Citation40
Germany	2006	PCV7	Positive	x				^Citation41
Germany	2005	PCV7	Positive	x	x	x		^Citation42
Ireland	2012	PCV10, PCV13	N/A				x	^Citation43
Ireland	2008	PCV7	N/A	x	x	x	x	^Citation44
Ireland	2007	PCV7	N/A				x	^Citation45
Italy	2019	PCV13 (PCV10 for one region)	Positive	x				^Citation46
Italy	2017	PCV13	Positive	x				^Citation47
Luxembourg	2016	PCV10, PCV13	Positive	x	x	x		^Citation48
Luxembourg	2011	PCV13	Positive	x	x	x		^Citation49
Netherlands	2013	PCV10, PCV13	Positive	x			x	^Citation50
Netherlands	2010	PCV10, PCV13	Positive	x	x		x	^Citation51
Netherlands	2005	PCV7	Negative	x	x	x	x	^Citation26
Netherlands	2003	PCV7	N/A	x	x	x	x	^Citation52
Netherlands	2002	PCV7	Negative	x			x	^Citation25
Norway	2006	PCV7	N/A	x	x	x	x	^Citation53
Poland	2014	PCV13	Positive	x		x	x	^Citation54
Portugal	2008	PCV7	Negative	x			x	^Citation22
Spain	2009	PCV10, PCV13	Positive	x		x	x	^Citation55
Spain	2006	PCV7	Positive	x				^Citation56
Sweden	2008	PCV7	N/A	x	x	x	x	^Citation57
Sweden	2008	PCV7	Positive	x			x	^Citation58
Switzerland	2020	PCV13	Positive					^Citation59
Switzerland	2019	PCV13	Positive	x	x			^Citation60
Switzerland	2010	PCV13	Positive	x				^Citation61
Switzerland	2007	PCV7	Positive	x	x	x		^Citation62
UK	2019	PCV13	Positive					^Citation63
UK	2018	PCV13	Positive					^Citation64
UK	2017	PCV13	Positive	x				^Citation65
UK	2014	PCV13	Positive					^Citation66
UK	2005	PCV7	Positive					^Citation67

Table 3. Epidemiological evidence, by type, disease, and country.

Country/Dimension	Austria	Belgium	Croatia	Denmark	Estonia	Finland	France	Germany	Ireland	Italy	Luxembourg	Netherlands	Norway	Poland	Portugal	Spain	Sweden	Switzerland	UK
IPD
Incidence	x	x	x			x	x	x	x	x	x	x	x	x	x	x	x	x	x
Prevalence				x	x	x	x	x		x				x		x
Mortality	x	x	x	x		x	x	x	x	x		x	x			x	x	x	x
Serotype distribution	x	x			x	x	x	x	x	x	x	x	x	x	x	x	x	x	x
% attributable to S. pneumoniae		x		x	x		x									x
Clinical presentation	x	x	x	x	x	x	x	x	x	x	x	x	x		x	x	x	x	x
AOM
Incidence		x	x	x	x	x	x	x	x		x	x	x				x	x
Prevalence					x	x	x
Mortality		x						x
Serotype distribution							x				x
% attributable to S. pneumoniae		x			x	x	x											x
Pneumonia
Incidence		x	x		x	x	x	x	x		x	x	x	x		x	x	x
Prevalence					x	x	x							x		x
Mortality		x	x			x	x	x	x								x
Serotype distribution							x
% attributable to S. pneumoniae		x	x		x	x
Clinical presentation		x	x		x	x	x	x	x		x	x		x

Table 4. Summary of CE-records.

Country	Year	Type of analysis (perspective)	Intervention	Comparator	Type of model	CE results
Belgium ^Citation29	2011	Cost-utility analysis (payer)	PCV10 and PCV13	PCV7	Markov model	Both PCV13 and PCV10 likely to be cost-effective in the base case setting. Varying results in sensitivity analyses.
Belgium ^Citation30	2006	Cost-effectiveness analysis (payer)	PCV7, either 3 + 1 or 2 + 1 dosing schedule	1) No vaccination 2) Incrementally between dosing schedules	Markov model	The 2 + 1 schedule carries an incremental cost per QALY that is likely to be acceptable in the Belgian health care system. The 3 + 1 schedule does not in relation to the 2 + 1 schedule.
Croatia ^Citation31	2015	Cost-effectiveness analysis (societal)	PCV10 and PCV13	No vaccination	Markov model	In the base case, vaccination likely carries a cost per QALY that is higher than what is commonly acceptable in Croatia. Scenario analyses suggest that a lower price of the evaluated vaccines would shift the cost per QALY toward acceptable levels.
Estonia ^Citation33	2015	Cost-effectiveness analysis (societal)	PCV10 and PCV13	No vaccination	Markov model	It is not possible to favor one of the interventions over the other. The incremental cost per QALY varies through scenarios. From highly likely to be at an acceptable level to less likely.
Germany ^Citation40	2008	Cost-effectiveness analysis (payer and societal)	PCV7	No vaccination	Markov model	General vaccination up to two years of life is cost saving. The assumptions regarding herd protection greatly impact these results.
Ireland ^Citation43	2012	Cost-effectiveness analysis (payer)	PCV13, PCV10 and PCV7	No vaccination	Markov model	PCV13 is referred to as the “most cost-effective option for childhood pneumococcal vaccination”.
Ireland ^Citation44	2008	Cost-effectiveness analysis (payer)	PCV7	No vaccination	Markov model	Implementation is cost-effective when including herd protection effects, otherwise not cost-effective.
Ireland ^Citation45	2007	Cost-effectiveness analysis (payer)	PCV7	No vaccination	Markov model	In the base case the cost per life year gained is deemed too high to be acceptable in the Irish health care system. With the inclusion of herd protection, the cost per life year gained is on a level which would potentially be acceptable.
Netherlands ^Citation52	2003	Cost-effectiveness analysis (societal)	PCV7	No vaccination	Decision tree	Implementation of PCV7 is not cost-effective given that the ICER is higher than what the authors state as the suggested willingness to pay (WTP) threshold in the Netherlands.
Norway ^Citation53	2006	Cost-effectiveness analysis (societal)	PCV7	No vaccination	Markov model	A three-dose regimen may be cost saving if it has the same effect as a four-dose regimen. A four-dose regimen is only cost-effective if both herd protection and indirect costs are considered.
Sweden ^Citation57	2008	Cost-effectiveness analysis (societal)	PCV7	No vaccination	Markov model	A three-dose regimen was found to be cost saving. A four-dose regimen without herd protection being considered carried an incremental cost per QALY gained that is likely acceptable in Sweden. When herd protection is considered, the incremental cost per QALY gained is low enough to be objectively seen as cost-effective.

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