OBJECTIVES: To evaluate the cost-utility of pneumococcal conjugate vaccines in Germany (societal perspective).
METHODS: An age-compartmental, one-year, steady-state population model was developed to estimate annual incremental cost savings (CS) and QALYs gained (QG) for pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV) and 13-valent pneumococcal candidate vaccine (PCV-13) compared with PCV-7. Two scenarios were evaluated: one considering effectiveness against Streptococcus pneumoniae (Sp) only, another including effectiveness against non-typable Haemophilus influenzae (NTHi) in acute otitis media (AOM) for PHiD-CV. Invasive pneumococcal disease (IPD) serotype-specififific effectiveness data were taken from US studies; effectiveness data for pneumonia were derived from the PCV-7 Kaiser Permanente trial and for AOM from two randomized European clinical trials. Epidemiological data and utility decrements were taken from published literature. DRGs (2008) provided the basis for stationary cost data, while ambulatory cost for pneumonia and AOM was estimated by experts. Other parameters included: vaccination coverage (90%), discount rate (3%), age-specific IPD herd immunity (30%[<18], 19%[18–64], 38%[>65]), price parity for all vaccines.
RESULTS: In the scenario considering effectiveness against Sp only, PCV-13 dominated both PCV-7 (CS: 5.8mn€, QG: 260.6) and PHiD-CV (CS: €3.2mn, QG: 159.9). In the scenario including effectiveness against NTHi in AOM, PHiD-CV dominated both PCV-7 (CS: €9.0mn, QG: 637.1) and PCV-13 (CS: €3.2mn, QG: 376.5). Results were robust in both one-way and probabilistic sensitivity analysis.
CONCLUSIONS: Including effectiveness against NTHi in AOM in the analysis, the protein-D conjugate vaccine PHiD-CV is cost saving compared to the CRM conjugate vaccines PCV-7 and the candidate vaccine PCV-13.
