Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia. Issue 7 (15th February 2017)

• Record Type: Journal Article
• Authors: Sundaram, Neisha; Chen, Cynthia; Yoong, Joanne; Luvsan, Munkh-Erdene; Fox, Kimberley; Sarankhuu, Amarzaya; La Vincente, Sophie; Jit, Mark
• Is Part Of: Vaccine. Volume 35:Issue 7(2017)
• Page Start: 1055
• Page End: 1063
• Publication Date: 2017-02-15
• Subjects: Pneumococcal conjugate vaccine -- Cost-effectiveness -- Mongolia -- Vaccine -- Budget impact -- PCV13; AMC advance market commitment -- AOM acute otitis media -- CFR case-fatality risk -- DALY disability-adjusted life year -- GDP gross domestic product -- GNI gross national income -- Hib haemophilus influenzae type b -- ICER incremental cost-effectiveness ratio -- IPD invasive pneumococcal disease -- MNT Mongolian tugrik -- MOH Ministry of Health -- NPNM non-pneumonia non-meningitis -- OOP out-of-pocket -- PAHO Pan American Health Organization -- PCV pneumococcal conjugate vaccine -- WPR Western Pacific region; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2016.12.070
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: Objective: The Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae . This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia. Methods: The incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance's advance market commitment tail price. Results: The ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920, 000 in 2016, and thereafter US$820, 000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440, 000 in the first year, increasing to US$510, 000 by 2025. Conclusion: Introducing PCV13 as part of Mongolia's national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.