Surasak Saokaew1,2,3, Ajaree Rayanakorn3, David Bin-Chia Wu3, Nathorn Chaiyakunapruk4,5,6,7. 1. Center of Health Outcomes Research and Therapeutic Safety (COHORTS), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand. 2. Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. 3. School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor Darul Ehsan, Malaysia. 4. Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. nathorn.chaiyakunapruk@monash.edu. 5. School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor Darul Ehsan, Malaysia. nathorn.chaiyakunapruk@monash.edu. 6. School of Population Health, University of Queensland, Brisbane, Australia. nathorn.chaiyakunapruk@monash.edu. 7. School of Pharmacy, University of Wisconsin, Madison, USA. nathorn.chaiyakunapruk@monash.edu.
Abstract
BACKGROUND: Although pneumococcal conjugate vaccines (PCVs) have been available for prevention of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae (S. pneumoniae) for over a decade, their adoption into national immunization programmes in low- and middle-income countries (LMICs) is still limited. Economic evaluations (EEs) play a crucial role in support of evidence-informed decisions. OBJECTIVE: This systematic review aims to provide a critical summary of EEs of PCVs and identify key drivers of EE findings in LMICs. METHODS: We searched Scopus, ISI Web of Science, PubMed, Embase and Cochrane Central from their inception to 30 September 2015 and limited the search to LMICs. The search was undertaken using the search strings 'pneumococc* AND conjugat* AND (vaccin* OR immun*)' AND 'economic OR cost-effectiveness OR cost-benefit OR cost-utility OR cost-effectiveness OR cost-benefit OR cost-utility' in the abstract, title or keyword fields. To be included, each study had to be a full EE of a PCV and conducted for an LMIC. Studies were extracted and reviewed by two authors. The review involved standard extraction of the study overview or the characteristics of the study, key drivers or parameters of the EE, assumptions behind the analyses and major areas of uncertainty. RESULTS: Out of 134 records identified, 22 articles were included. Seven studies used a Markov model for analysis, while 15 studies used a decision-tree analytic model. Eighteen studies performed a cost-utility analysis (CUA), with disability-adjusted life-years, quality-adjusted life-years or life-years gained as a measure of health outcome, while four studies focused only on cost-effectiveness analysis (CEA). Both CEA and CUA findings were provided by eight studies. Herd effects and serotype replacement were considered in 10 and 13 studies, respectively. The current evidence shows that both the 10-valent and 13-valent PCVs are probably cost effective in comparison with the 7-valent PCV or no vaccination. The most influential parameters were vaccine efficacy and coverage (in 16 of 22 studies), vaccine price (in 13 of 22 studies), disease incidence (in 11 of 22 studies), mortality from IPD and pneumonia (in 8 of 22 studies) and herd effects (in 4 of 22 studies). The findings were found to be supportive of the products owned by the manufacturers. CONCLUSION: Our review demonstrated that an infant PCV programme was a cost-effective intervention in most LMICs (in 20 of 22 studies included). The results were sensitive to vaccine efficacy, price, burden of disease and sponsorship. Decision makers should consider EE findings and affordability before adoption of PCVs.
BACKGROUND: Although pneumococcal conjugate vaccines (PCVs) have been available for prevention of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae (S. pneumoniae) for over a decade, their adoption into national immunization programmes in low- and middle-income countries (LMICs) is still limited. Economic evaluations (EEs) play a crucial role in support of evidence-informed decisions. OBJECTIVE: This systematic review aims to provide a critical summary of EEs of PCVs and identify key drivers of EE findings in LMICs. METHODS: We searched Scopus, ISI Web of Science, PubMed, Embase and Cochrane Central from their inception to 30 September 2015 and limited the search to LMICs. The search was undertaken using the search strings 'pneumococc* AND conjugat* AND (vaccin* OR immun*)' AND 'economic OR cost-effectiveness OR cost-benefit OR cost-utility OR cost-effectiveness OR cost-benefit OR cost-utility' in the abstract, title or keyword fields. To be included, each study had to be a full EE of a PCV and conducted for an LMIC. Studies were extracted and reviewed by two authors. The review involved standard extraction of the study overview or the characteristics of the study, key drivers or parameters of the EE, assumptions behind the analyses and major areas of uncertainty. RESULTS: Out of 134 records identified, 22 articles were included. Seven studies used a Markov model for analysis, while 15 studies used a decision-tree analytic model. Eighteen studies performed a cost-utility analysis (CUA), with disability-adjusted life-years, quality-adjusted life-years or life-years gained as a measure of health outcome, while four studies focused only on cost-effectiveness analysis (CEA). Both CEA and CUA findings were provided by eight studies. Herd effects and serotype replacement were considered in 10 and 13 studies, respectively. The current evidence shows that both the 10-valent and 13-valent PCVs are probably cost effective in comparison with the 7-valent PCV or no vaccination. The most influential parameters were vaccine efficacy and coverage (in 16 of 22 studies), vaccine price (in 13 of 22 studies), disease incidence (in 11 of 22 studies), mortality from IPD and pneumonia (in 8 of 22 studies) and herd effects (in 4 of 22 studies). The findings were found to be supportive of the products owned by the manufacturers. CONCLUSION: Our review demonstrated that an infant PCV programme was a cost-effective intervention in most LMICs (in 20 of 22 studies included). The results were sensitive to vaccine efficacy, price, burden of disease and sponsorship. Decision makers should consider EE findings and affordability before adoption of PCVs.
Authors: Andrew Clark; Barbara Jauregui; Ulla Griffiths; Cara B Janusz; Brenda Bolaños-Sierra; Rana Hajjeh; Jon K Andrus; Colin Sanderson Journal: Vaccine Date: 2013-07-02 Impact factor: 3.641
Authors: Carlos Castañeda-Orjuela; Nelson Alvis-Guzmán; Martha Velandia-González; Fernando De la Hoz-Restrepo Journal: Vaccine Date: 2012-01-21 Impact factor: 3.641
Authors: Steven B Black; Henry R Shinefield; Stella Ling; John Hansen; Bruce Fireman; David Spring; Jack Noyes; Edwin Lewis; Paula Ray; Janelle Lee; Jill Hackell Journal: Pediatr Infect Dis J Date: 2002-09 Impact factor: 2.129
Authors: Mari M Nakamura; Azadeh Tasslimi; Tracy A Lieu; Orin Levine; Maria Deloria Knoll; Louise B Russell; Anushua Sinha Journal: Int Health Date: 2011-12 Impact factor: 2.473
Authors: Richard Pitman; David Fisman; Gregory S Zaric; Maarten Postma; Mirjam Kretzschmar; John Edmunds; Marc Brisson Journal: Value Health Date: 2012 Sep-Oct Impact factor: 5.725
Authors: Kunling Shen; Matthew Wasserman; Dongdong Liu; Yong-Hong Yang; Junfeng Yang; Greg F Guzauskas; Bruce C M Wang; Betsy Hilton; Raymond Farkouh Journal: PLoS One Date: 2018-07-25 Impact factor: 3.240
Authors: Charles H Jones; Guojian Zhang; Roozbeh Nayerhoda; Marie Beitelshees; Andrew Hill; Pooya Rostami; Yi Li; Bruce A Davidson; Paul Knight; Blaine A Pfeifer Journal: Sci Adv Date: 2017-10-18 Impact factor: 14.136
Authors: William S Pomat; Anita H J van den Biggelaar; Sandra Wana; Jacinta P Francis; Vela Solomon; Andrew R Greenhill; Rebecca Ford; Tilda Orami; Megan Passey; Peter Jacoby; Lea-Ann Kirkham; Deborah Lehmann; Peter C Richmond Journal: Clin Infect Dis Date: 2019-04-24 Impact factor: 9.079