EVALUATING THE ECONOMIC IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINES IN ECUADOR, HONDURAS AND PARAGUAY D. Constenla Johns Hopkins Bloomberg School of Public Health -­‐ InternaLonal Vaccine Access Center INTRODUCTION Pneumococcal disease causes significant burden. Health and economic data help to establish the value of vaccina)on to reduce this burden. METHODS An economic model was constructed to es)mate the cost-­‐effec)veness of the three available pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) from the societal perspec)ve in Ecuador, Honduras and Paraguay. Hypothe)cal birth cohorts were followed for a 20-­‐year period in each country. Costs were expressed in 2010 US dollars. Sensi)vity analyses were performed to assess the impact of the uncertainty on es)mates. Table 2. Comparing the cost-­‐effecLveness of alternaLve intervenLons – only PCV7 CE results shown RESULTS Low-­‐income Honduras experienced the greatest health burden (351 DALYs/1,000 children) due to pneumococcal disease. Over the 20 years of vaccine program implementa)on, the healthcare costs of pneumococcal disease would range from US$13,428,396 to US$18,485,142. Vaccina)on would prevent more than 50% of pneumococcal cases and deaths. At a cost of US
$16.90/dose, the cost per DALY averted compared to no vaccine ranged from US$1,002 (Honduras) to US$1,677 (Ecuador), US$796 (Honduras) to US$1,340 (Ecuador), US$691 (Honduras) to US$1,166 (Ecuador) for PCV7, PCV10 and PCV13 respec)vely. At a reduced price (US$7/dose), the cost per DALY averted ranged from US$418 (Honduras) to US$668 (Ecuador), US$327 (Honduras) to US$528 (Ecuador), US$281 (Honduras) to US$456 (Ecuador) for PCV7, PCV10, PCV13 respec)vely. Figure 1 shows the results of the Monte Carlo simula)on as an acceptability curve, which allows decision-­‐makers to determine the probability that pneumococcal conjugate vaccina)on is cost-­‐effec)ve at various willingness-­‐to-­‐pay thresholds (the highest incremental cost-­‐effec)veness ra)o that people would be willing to accept as reasonable value for the health care dollar). For each country it shows the likelihood (ver)cal axis) that vaccina)on (PCV7) would have an ICER less than a specific $/DALY level (horizontal axis). Figure 1: Cost acceptability curve for pneumococcal conjugate vaccinaLon in selected LaLn American countries Figure 2. SchemaLc diagram of model Pneumococcal pneumonia (non-­‐severe) Clinical % due to Pneumonia Pneumococcal <5 * Countries are classified by Episodes the World Health Organiza)on according to region and mortality stratum. Pneumococcal † Cost-­‐effec)veness ra)o is based on societal perspec)ve. ‡ Cost-­‐effec)veness ra)o is based on healthcare perspec)ve. pneumonia (severe) Birth cohort Table 1. EsLmated cost-­‐effecLveness of vaccinaLon for Ecuador, Honduras, Paraguay (US$ 2011) – only PCV7 CE results shown Ecuador
Honduras
Paraguay
US$1,677 US$1,002 US$1,370 At US$13 per dose
US$1,280 US$772 US$1,104 US$668 US$418 US$535 At US$7 per dose
ICER (US$ per life year gained) ‡ (societal perspec)ve)
At US$16.90 per dose
US$1,716 US$1,288 US$1,416 At US$13 per dose
US$1,316 US$786 US$1,126 US$687 US$425 US$546 At US$7 per dose
ICER (US$ per death averted) ‡ (societal perspec)ve)
At US$16.90 per dose
US$63,289 US$34,067 US$52,525 At US$13 per dose
US$45,214 US$26,758 US$38,453 At US$7 per dose
US$23,608 US$14,484 US$18,645 US$1,671
US$1,411 US$1,532 At US$13 per dose
US$955
US$946 US$761 At US$7 per dose
US$499 US$512 US$369 ICER (US$ per case averted) ‡ (societal perspec)ve)
At US$16.90 per dose
ICER (US$ per hospitaliza)on averted) ‡ (societal perspec)ve)
At US$16.90 per dose
US$13,197
US$12,478 US$9,383 At US$13 per dose
US$11,243 US$11,124 US$9,031 At US$7 per dose
US$5,870 US$6,022 US$4,379 ‡Discounted Minor sequelae Pneumococcal meningi)s Pneumococcal Invasive NPNM ICER (US$ per DALY averted) ‡ (societal perspec)ve)
At US$16.90 per dose
Pneumococcal deaths Survivors Major sequelae CONCLUSION The cost-­‐effec)veness of vaccina)on compared to other interven)ons directed at reducing pneumococcal mortality will depend on the serotype coverage, vaccine price and ability of vaccina)on programs to reach children at risk of mortality in a )mely manner. ACKNOWLEDGMENT This work was funded by the Pneumococcal Vaccines Accelerated Development and Introduc)on Plan (PneumoADIP) at the Johns Hopkins Bloomberg School of Public Health (JHSPH), but full independence of methods and control over publica)on remain with the authors along with responsibility for any errors. The authors thank all local clinicians from Ecuador, Honduras and Paraguay for their expert advice. REFERENCES References are sited in Table 2. Comparing the cost-­‐effec)veness of alterna)ve interven)ons -­‐ only PCV7 CE results shown. © Interna)onal Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health 2012 Al Rights Reserved