Response to Gomez et al.'s Letter to the Editor Regarding: "Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Versus Lower-Valent Alternatives in Filipino Infants".

We thank Gomez and colleagues for their interest in our study “Cost-effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) versus lower-valent alternatives in Filipino infants.” Gomez and colleagues raised several concerns regarding study methodology and input parameters which were very similar to previously published letters to the editor, for which there are several published responses [1-4]. We would like to reiterate that the cost-effectiveness model used for this study uses the same assumptions as many other peer-reviewed studies of countries, including Australia, Brazil, Canada, Colombia, Finland, Italy, Malaysia, Mexico, and the Netherlands [5-11]. This scientific methodology used for pneumococcal disease serotype trends is recognized and is a strength of this study, because we are able to show with numerous predictions from multiple countries the possible range of outcomes when switching from PCV13 to lower-valent PCV alternatives. While we agree that local data may present uncertainties, as discussed extensively in the limitations section of our study, most of our data were sourced from the cost-utility analysis conducted by the Department of Health (DOH) of the Philippines in the 2020 Health Technology Assessment (HTA) of pneumococcal conjugate vaccines (PCV), and are subject to the same inherent limitations [12]. While Gomez and colleagues highlighted the savings from 5-year incremental program costs, our study results are consistent with the 2020 HTA PCV Reassessment conducted by the DOH on the overall healthcare and societal cost savings, which are especially necessary to inform decision-makers on the cost-effectiveness of PCV use.

In closing, we thank Gomez and colleagues for their assessment of our manuscript. We hope that our response and citations provide more clarity around our analysis.