Cost effectiveness of child pneumococcal conjugate vaccination in middle-income countries

Nakamura, Mari M.; Tasslimi, Azadeh; Lieu, Tracy A.; Levine, Orin; Knoll, Maria Deloria; Russell, Louise B.; Sinha, Anushua

doi:10.1016/j.inhe.2011.08.004

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Volume 3, Issue 4 , Pages 270-281, December 2011

Cost effectiveness of child pneumococcal conjugate vaccination in middle-income countries

Mari M. Nakamura
- Division of Infectious Diseases, Department of Medicine and Information Services Department, Children's Hospital Boston, 300 Longwood Avenue, Enders 7, Boston, MA 02115, USA
- Corresponding author. Tel.: +1 617 919 2900; fax: +1 617 730 0254.
Azadeh Tasslimi
- Department of Preventive Medicine and Community Health, University of Medicine & Dentistry of New Jersey–New Jersey Medical School, Newark, NJ, USA
Tracy A. Lieu
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Pilgrim Health Care & Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Boston, MA, USA
Orin Levine
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Louise B. Russell
- Institute for Health, Health Care Policy and Aging Research, and Department of Economics, Rutgers University, New Brunswick, NJ, USA
Anushua Sinha
- Department of Preventive Medicine and Community Health, University of Medicine & Dentistry of New Jersey–New Jersey Medical School, Newark, NJ, USA

Received 24 September 2010; received in revised form 30 March 2011; accepted 17 August 2011. published online 11 November 2011.

Abstract

Policy-makers require information on the potential benefits of and economic case for pneumococcal conjugate vaccination in middle-income countries. We built decision analysis models to evaluate a three-dose infant series of the 7-, 10- or 13-valent pneumococcal conjugate vaccines in 77 middle-income countries compared with no vaccination, accounting for direct protection of vaccinated children as well as herd protection and serotype replacement in unvaccinated children and adults. Over 10 years, pneumococcal vaccination would prevent at least 11.0 million cases and 314000 deaths in children under-5, one-third of the pneumonia and invasive disease cases and deaths that would occur in this age group without vaccination. Herd protection would prevent 3.1 million cases and 163000 deaths in older children and adults. A total of 11.1 million discounted disability-adjusted life-years (DALY) would be averted. At a dose cost of $10 for lower- middle-income and $20 for upper-middle-income countries, the net pooled (for all countries together) discounted vaccination cost would be $18.1 billion ($1600 per DALY averted). Vaccination would be cost effective for 72 countries with the 7-valent vaccine and for all countries with the 10- or 13-valent vaccines. The economic case for vaccination is compelling for middle-income countries.