Cost-effectiveness of 13-valent pneumococcal polysaccharide conjugate vaccine in Indian adults aged ≥50 years

Lacking national policy for adult pneumococcal vaccination, local Indian guidelines recommend 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV23). However, no vaccination (‘NV’) or PPV23 alone are most common in clinical practice. We evaluated cost-effectiveness of PCV13 versus NV and, alternatively, PPV23 in India. Cohort model with Markov-type process projected lifetime cases, deaths, and costs associated with invasive pneumococcal disease and all-cause non-bacteremic pneumonia (discounting = 5%/year). Cost per quality-adjusted life year (QALY) gained was assessed among at-risk/high-risk adults aged 50–59 years and all aged 60–99 years (<i>N</i> = 209.5 M) from private/patient and government/payer perspectives, which differed on medical costs, vaccination costs, and uptake rates. From private/patient perspective, PCV13 versus NV yielded ₹480,908/QALY (ΔCosts=₹27.2B;ΔQALYs = 56,560), whereas PCV13 was dominant versus PPV23 (ΔCosts=-₹359.1 M; ΔQALYs = 53,861).From government/payer perspective, corresponding ratios were ₹610,178/QALY (ΔCosts=₹84.4B;ΔQALYs = 138,382), and ₹456,048/QALY (ΔCosts=₹60.2B; ΔQALYs = 131,933). In probabilistic sensitivity analyses, cost-effectiveness was &lt;₹600,000/QALY in 72.9%-99.7% of replications (<i>N</i> = 1000/analysis), depending on comparison/perspective. PCV13 versus NV among at-risk/high-risk adults aged 50–59 years and all aged ≥ 60 years would be cost-effective from both perspectives considering willingness-to-pay equaling approximately 3× gross domestic product/capita. Furthermore, PCV13 versus PPV23 would be cost-effective and cost saving from government/payer and private/patient perspectives, respectively.

由于印度缺乏成人肺炎球菌疫苗接种的国家政策，当地指南推荐先接种13价肺炎球菌多糖结合疫苗（13-valent pneumococcal polysaccharide conjugate vaccine, PCV13），再接种23价肺炎球菌多糖疫苗（23-valent pneumococcal polysaccharide vaccine, PPV23）。但临床实践中最常见的方案为未接种疫苗（no vaccination, NV）或仅接种PPV23。本研究评估了印度地区PCV13分别对比NV、以及PCV13对比PPV23的成本效益。本研究采用基于马尔可夫过程的队列模型，对侵袭性肺炎球菌疾病与全因非菌血症性肺炎相关的终身病例数、死亡数及成本进行预测，贴现率设定为5%/年。本研究从私人/患者方与政府/支付方两个视角，对50~59岁的风险人群与高风险成人，以及60~99岁全体成人（总人群规模N=209.5百万）的每获得1个质量调整生命年（quality-adjusted life year, QALY）所需成本进行评估；两类视角在医疗成本、疫苗接种成本及疫苗接种率方面存在差异。从私人/患者视角来看，PCV13对比NV的增量成本效益比为480908印度卢比/QALY（增量成本=272亿印度卢比；增量QALYs=56560）；而PCV13对比PPV23则具有成本优势（增量成本=-3.591亿印度卢比；增量QALYs=53861）。从政府/支付方视角来看，对应的增量成本效益比分别为610178印度卢比/QALY（增量成本=844亿印度卢比；增量QALYs=138382），以及456048印度卢比/QALY（增量成本=602亿印度卢比；增量QALYs=131933）。在概率敏感性分析中，根据对比方案与分析视角的不同，72.9%~99.7%的重复模拟结果（每次分析重复1000次）显示，其成本效益比低于600000印度卢比/QALY。当支付意愿约为人均国内生产总值的3倍时，从两类视角来看，对50~59岁的风险人群与高风险成人以及60岁及以上全体成人采用PCV13对比NV的方案均具有成本效益。此外，从政府/支付方视角与私人/患者方视角来看，PCV13对比PPV23的方案分别具有成本效益与成本节约优势。