Abstract：
OBJECTIVE: The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants in Argentina\'s national immunization program (NIP) in a 2 + 1 schedule since 2012. Licensure of the 15-valent vaccine (PCV15) is anticipated soon, and the 20-valent vaccine (PCV20) recently received regulatory approval. This cost-effectiveness analysis examined the public health and economic implications of transitioning from PCV13 to either PCV15 or PCV20 in Argentina\'s pediatric NIP.
METHODS: A decision-analytic Markov model was used with a 10-year time horizon and a 3.0% annual discount rate for costs and benefits. Vaccine effectiveness estimates were derived from Argentinian surveillance data, PCV13 clinical effectiveness and impact studies, and PCV7 efficacy studies. Population, epidemiologic, and economic inputs were obtained from literature and Argentinian-specific data. The study adopted a healthcare system perspective; sensitivity and scenario analyses were conducted to assess input parameters and structural uncertainty.
RESULTS: Compared with PCV13, PCV20 was estimated to avert an additional 7,378, 42,884, and 172,389 cases of invasive pneumococcal disease (IPD), all-cause pneumonia, and all-cause otitis media (OM), respectively, as well as 3,308 deaths, resulting in savings of United States Dollars (USD) 50,973,962 in direct medical costs. Compared with PCV15, PCV20 was also estimated to have greater benefit, averting an additional 6,140, 35,258, and 142,366 cases of IPD, pneumonia, and OM, respectively, as well as 2,624 deaths, resulting in savings of USD 37,697,868 in direct medical costs. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. Results remained robust in sensitivity analyses and scenario assessments.
CONCLUSIONS: Over a 10-year horizon, vaccination with PCV20 was expected to be the dominant, cost-saving strategy versus PCV13 and PCV15 in children in Argentina. Policymakers should consider the PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared with lower-valent options.
METHODS: A decision-analytic Markov model was used with a 10-year time horizon and a 3.0% annual discount rate for costs and benefits. Vaccine effectiveness estimates were derived from Argentinian surveillance data, PCV13 clinical effectiveness and impact studies, and PCV7 efficacy studies. Population, epidemiologic, and economic inputs were obtained from literature and Argentinian-specific data. The study adopted a healthcare system perspective; sensitivity and scenario analyses were conducted to assess input parameters and structural uncertainty.
RESULTS: Compared with PCV13, PCV20 was estimated to avert an additional 7,378, 42,884, and 172,389 cases of invasive pneumococcal disease (IPD), all-cause pneumonia, and all-cause otitis media (OM), respectively, as well as 3,308 deaths, resulting in savings of United States Dollars (USD) 50,973,962 in direct medical costs. Compared with PCV15, PCV20 was also estimated to have greater benefit, averting an additional 6,140, 35,258, and 142,366 cases of IPD, pneumonia, and OM, respectively, as well as 2,624 deaths, resulting in savings of USD 37,697,868 in direct medical costs. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. Results remained robust in sensitivity analyses and scenario assessments.
CONCLUSIONS: Over a 10-year horizon, vaccination with PCV20 was expected to be the dominant, cost-saving strategy versus PCV13 and PCV15 in children in Argentina. Policymakers should consider the PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared with lower-valent options.
摘要：
目的：自2012年以来，阿根廷国家免疫计划（NIP）中的婴儿推荐使用13价肺炎球菌结合疫苗（PCV13）。预计将很快获得15价疫苗(PCV15)的许可，20价疫苗（PCV20）最近获得了监管部门的批准。这项成本效益分析研究了阿根廷儿科NIP从PCV13过渡到PCV15或PCV20的公共卫生和经济影响。
方法：使用了一个决策分析马尔可夫模型，其时间范围为10年，成本和收益的年折现率为3.0％。疫苗有效性估计来自阿根廷的监测数据，PCV13临床有效性和影响研究，和PCV7疗效研究。人口,流行病学,经济投入是从文献和阿根廷特有的数据中获得的。该研究采用了医疗保健系统的观点；进行了敏感性和情景分析，以评估输入参数和结构不确定性。
结果：与PCV13相比，估计PCV20避免了另外7,378、42,884和172,389例侵袭性肺炎球菌疾病（IPD），全因肺炎,和全因中耳炎（OM），分别,以及3308人死亡,从而节省了50,973,962美元的直接医疗费用。与PCV15相比，PCV20估计也有更大的益处，避免了另外6,140,35,258和142,366例IPD，肺炎,OM,分别,以及2,624人死亡，节省了37,697,868美元的直接医疗费用。PCV20与更高的质量调整寿命年增益和更低的成本相关(即，优势)与PCV13和PCV15。在敏感性分析和情景评估中，结果仍然稳健。
结论：在10年内，预计PCV20疫苗将占主导地位，阿根廷儿童的成本节约策略与PCV13和PCV15的比较。与低价方案相比，政策制定者应考虑PCV20疫苗接种策略，以实现最大的临床和经济效益。
方法：使用了一个决策分析马尔可夫模型，其时间范围为10年，成本和收益的年折现率为3.0％。疫苗有效性估计来自阿根廷的监测数据，PCV13临床有效性和影响研究，和PCV7疗效研究。人口,流行病学,经济投入是从文献和阿根廷特有的数据中获得的。该研究采用了医疗保健系统的观点；进行了敏感性和情景分析，以评估输入参数和结构不确定性。
结果：与PCV13相比，估计PCV20避免了另外7,378、42,884和172,389例侵袭性肺炎球菌疾病（IPD），全因肺炎,和全因中耳炎（OM），分别,以及3308人死亡,从而节省了50,973,962美元的直接医疗费用。与PCV15相比，PCV20估计也有更大的益处，避免了另外6,140,35,258和142,366例IPD，肺炎,OM,分别,以及2,624人死亡，节省了37,697,868美元的直接医疗费用。PCV20与更高的质量调整寿命年增益和更低的成本相关(即，优势)与PCV13和PCV15。在敏感性分析和情景评估中，结果仍然稳健。
结论：在10年内，预计PCV20疫苗将占主导地位，阿根廷儿童的成本节约策略与PCV13和PCV15的比较。与低价方案相比，政策制定者应考虑PCV20疫苗接种策略，以实现最大的临床和经济效益。
