Cost-effectiveness evaluation of pneumococcal conjugate vaccine 13-valent compared to the polysaccharide pneumococcal vaccine and non-vaccination in the Brazilian Supplementary Health System

Abstract

Objective: Diseases caused by the bacteria Streptococcus pneumoniae are important sources of morbidity and mortality around the world, specially in regard to elderly people. We sought to assess costs and benefits inherent to 13-valent pneumococcal conjugate vaccine (PCV13, Prevenar® 13) compared to pneumococcal polysaccharide vacine (PPSV23) and the policy of does providing vaccine in the perspective of Brazilian Private Health System. Methods: A cost-effectiveness analysis model was performed by means of a Markov modelling which comprised the health states healthy, pneumococcal disease and death. In this study were included clinical data of patients with pneumococcal disease (bacteremia, meningitis, hospitalization due to pneumonia and community acquired pneumonia) and direct and indirect medical costs. A three year time horizon and an annual cycle were set. The hypothetic cohort corresponds to patients aging 50 years or more. One-way and probabilistic sensitivity analyses were performed. Results: PCV13 is dominant over PPSV23 and non- -vaccination policy in low- moderate- and high-risk patients. Probabilistic analysis shows that PCV13 has a probability of being 90% more cost-effective when a threshold of BRL 12.000 is defined for each incremental life-year gained. Conclusions: Considering the outcome life-years gained PCV13 is the strategy that most promote value for money in patients aging 50 years or more, in the Brazilian Private Health System.