Cost-effectiveness of a 13-valent pneumococcal conjugate vaccine compared with currently available pneumococcal conjugate vaccines in Indian children.

Objectives: Four pneumococcal conjugate vaccines (PCVs) are available for infant immunization in India's private sector: a 13-valent (PCV13-PFE), two 10-valent (PCV10-GSK, PCV10-SII), and a 14-valent (PCV14-BE).

Methods: Based on the India label dosing for each, a decision-analytic Markov model was used to compare the health and economic impacts and cost-effectiveness of PCV13-PFE (3+1) vs PCV10-SII (3+0), PCV10-GSK (3+1), or PCV14-BE (3+0). Pneumococcal disease (PD) incidence, serotype distribution, costs, and utility inputs were derived from published studies and local evidence. Adjustment for the estimated direct vaccine effects following the specified dosing schedules was applied to PCV10-SII and PCV14-BE. A willingness-to-pay threshold of INR 590,949 per quality-adjusted life-year (QALY) was used to assess cost-effectiveness.

Results: PCV13-PFE was estimated to prevent an additional 255,060, 40,336, and 247,750 total cases of PD compared to PCV10-SII, PCV10-GSK, and PCV14-BE, respectively, over 10 years. Compared to these alternative PCVs, PCV13-PFE was estimated to result in additional direct disease cost savings of INR 22.5 billion, INR 3.63 billion, and INR 21.9 billion from PD cases prevented. This yielded incremental cost-effectiveness ratios (ICERs) for PCV13-PFE vs PCV10-SII and PCV10-GSK of INR 18,142 and INR 304,234 per QALY, respectively, both below the willingness-to-pay threshold of INR 590,949. PCV13-PFE was cost-saving compared to PCV14-BE.

Conclusions: From the private sector perspective, vaccinating children in India with PCV13-PFE could prevent more PD cases, save more PD-associated medical costs, and be more cost-effective than other locally available PCV options.