Pfizer bv, Capelle a/d IJssel, The Netherlands.
Clin Ther. 2013 Feb;35(2):119-34. doi: 10.1016/j.clinthera.2012.12.006. Epub 2013 Jan 10.
The introduction of a 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7) had profound public health effects across the globe. PCV7 vaccination in a national immunization program is generally considered cost-effective and potentially cost-saving. Two new PCVs have been launched, a 10-valent pneumococcal conjugate vaccine (PCV10) and a 13-valent pneumococcal conjugate vaccine (PCV13).
This article examines the public health and economic effects of pediatric national immunization programs of PCV10 and PCV13 in Denmark and Sweden.
A previously published decision-analytic model was used to estimate the impact of PCV10 and PCV13 on reducing cases of invasive pneumococcal disease (IPD), pneumonia (PNE), and acute otitis media (AOM) by using country-specific incidence, serotype coverage, disease sequelae, mortality, vaccine effectiveness, indirect effects, costs, and utilities. Direct effects for PCV13- and PCV10-covered serotypes were assumed similar to PCV7. PCV13 was assumed to confer an indirect effect, similar to PCV7, whereas PCV10 was not. Assumptions were tested in sensitivity analyses.
PCV13 is expected to save 280.7 million DKK (Danish kroner) in Denmark and 288.2 million SEK (Swedish kronor) in Sweden in direct costs compared with a vaccination program with PCV10. In both Denmark and Sweden, the results of this study indicate that, compared with PCV10, PCV13 will have a greater impact on disease in life-years gained (LYG), quality-adjusted life-years (QALYs) gained, IPD cases avoided, PNE cases avoided, AOM cases avoided, and in deaths avoided. For Denmark PCV13, it was estimated to result in 10,051 LYG; 9063 QALYs gained; 237 additional IPD cases avoided; 12,094 additional PNE cases avoided; 958 additional cases of AOM avoided; and 882 additional deaths avoided. For Sweden PCV13, it was estimated to result in 4245 LYG; 3953 QALYs gained; 379 additional IPD cases avoided; 8210 additional PNE cases avoided; 1459 additional cases of AOM avoided; and 378 additional deaths avoided. In all sensitivity analyses, PCV13 was less costly and more effective compared with PCV10.
In this analysis, a national immunization program with PCV13 was found to be good value for money and estimated to prevent additional cases of disease among children and nonvaccinated individuals and save additional costs due to treatment of pneumococcal disease, when compared with PCV10 in Denmark and Sweden.
全球范围内，7 价肺炎球菌多糖结合疫苗（PCV7）的推出产生了深远的公共卫生影响。在国家免疫计划中接种 PCV7 通常被认为具有成本效益，并且具有潜在的成本节约效果。两种新的 PCV 已推出，即 10 价肺炎球菌结合疫苗（PCV10）和 13 价肺炎球菌结合疫苗（PCV13）。
本文旨在研究丹麦和瑞典的儿童国家免疫计划中 PCV10 和 PCV13 的公共卫生和经济效益。
使用先前发表的决策分析模型，根据国家发病率、血清型覆盖率、疾病后遗症、死亡率、疫苗效力、间接效应、成本和效用，估计 PCV10 和 PCV13 对减少侵袭性肺炎球菌病（IPD）、肺炎（PNE）和急性中耳炎（AOM）病例的影响。假设 PCV13 和 PCV10 覆盖的血清型的直接影响与 PCV7 相似。假设 PCV13 会产生类似于 PCV7 的间接影响，而 PCV10 则不会。在敏感性分析中对假设进行了测试。
与接种 PCV10 的疫苗接种计划相比，PCV13 预计将为丹麦节省 2.807 亿丹麦克朗（丹麦克朗），为瑞典节省 2.882 亿瑞典克朗（瑞典克朗）的直接成本。在丹麦和瑞典，本研究的结果表明，与 PCV10 相比，PCV13 对生命年获益（LYG）、质量调整生命年（QALY）获益、IPD 病例避免、PNE 病例避免、AOM 病例避免和避免死亡的影响更大。对于丹麦的 PCV13，据估计将产生 10051 个 LYG；9063 个 QALYs 获益；237 例额外的 IPD 病例避免；12094 例额外的 PNE 病例避免；958 例额外的 AOM 病例避免；和 882 例额外的死亡避免。对于瑞典的 PCV13，据估计将产生 4245 个 LYG；3953 个 QALYs 获益；379 例额外的 IPD 病例避免；8210 例额外的 PNE 病例避免；1459 例额外的 AOM 病例避免；和 378 例额外的死亡避免。在所有敏感性分析中，PCV13 的成本均低于 PCV10，且效果更好。
在这项分析中，与丹麦和瑞典的 PCV10 相比，全国免疫计划中的 PCV13 被认为是物有所值的，并且预计可以预防儿童和未接种人群的疾病，减少因治疗肺炎球菌疾病而产生的额外费用。
