Cost-effectiveness of 13-valent pneumococcal vaccine for children under 5 years of age at high altitude in China: A modeling analysis.

Abstract

Background: Pneumococcal disease poses a significant health burden in China, especially in economically underdeveloped areas in western China, such as the Qinghai-Tibet Plateau. Globally, Pneumococcal Conjugate Vaccines (PCV) have greatly reduced the burden of pneumococcal disease, but PCV has not yet been included in the National Immunization Program (NIP) in China. Consequently, most of the population remains unvaccinated with PCV. This study aimed to evaluate the cost-effectiveness of introducing 13-valent Pneumococcal Conjugate Vaccine (PCV13) into the NIP and to provide a basis for decision-making for the government and health administrative departments of Qinghai Province.

Methods: We used a decision-tree Markov model to estimate the cost-effectiveness of adding a 4-dose PCV13 schedule to the NIP compared to the current situation where it is available only in the private market (status quo). The analysis focused on the 2022 birth cohort in Qinghai Province and was conducted from a societal perspective. The results were presented in terms of cases and deaths prevented, quality-adjusted life years gained, and the incremental cost-effectiveness ratio. We conducted 1-way, scenario, and probabilistic sensitivity analyses to explore model uncertainty.

Results: Introducing PCV13 into the NIP was projected to prevent approximately 7493 pneumococcal cases (a 75.60% reduction) and 146 pneumococcal deaths (a 93.59% reduction) in the first 5 years of the 2022 Qinghai Province birth cohort. At the current price of US $68.00 per dose of PCV13, introducing PCV13 into the NIP was found to be cost-effective and showed cost savings. One-way and scenario sensitivity analyses indicated robust results, and probabilistic sensitivity analysis showed a 99% probability of cost-effectiveness.

Conclusion: The introduction of PCV13 into the NIP is a cost-effective strategy for Qinghai Province. We recommend reducing the vaccine price through government bulk tenders and large-scale procurement to further improve cost-effectiveness and suggest introducing PCV13 into the immunization program of Qinghai in due course.