Mezones-Holguin Edward, Canelo-Aybar Carlos, Clark Andrew David, Janusz Cara Bess, Jaúregui Bárbara, Escobedo-Palza Seimer, Hernandez Adrian V, Vega-Porras Denhiking, González Marco, Fiestas Fabián, Toledo Washington, Michel Fabiana, Suárez Víctor J
Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP), Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru.
Vaccine. 2015 May 7;33 Suppl 1:A154-66. doi: 10.1016/j.vaccine.2014.12.039.
To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age.
The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed.
For the 20 cohorts, net costs with PCV10 and PCV13 were US$ 363.26 million and US$ 408.26 million, respectively. PCV10 prevented 570,273 AOM; 79,937 PP; 2217 PM; 3049 PS; 282 NS; 173 AS; and 7512 deaths. PCV13 prevented 419,815 AOM; 112,331 PN; 3116 PM; 4285 PS; 404 NS; 248 AS; and 10,386 deaths. Avoided DALYs were 226,370 with PCV10 and 313,119 with PCV13. Saved treatment costs were US$ 37.39 million with PCV10 and US$ 47.22 million with PCV13. Costs per DALY averted were US$ 1605 for PCV10, and US$ 1304 for PCV13. Sensitivity analyses showed similar results. PCV13 has an extended dominance over PCV10.
Both pneumococcal vaccines are cost effective in the Peruvian context. Although the net cost of vaccination with PCV10 is lower, PCV13 prevented more deaths, pneumococcal complications and sequelae. Costs per each prevented DALY were lower with PCV13. Thus, PCV13 would be the preferred policy; PCV10 would also be reasonable (and cost-saving relative to the status quo) if for some reason 13-valent were not feasible.
评估在秘鲁国家免疫规划中引入10价肺炎球菌结合疫苗（PCV10）与13价肺炎球菌结合疫苗（PCV13）预防5岁以下儿童肺炎球菌疾病（PD）的成本效益。
从秘鲁政府的角度应用泛美卫生组织ProVac倡议（2.0版）的综合TRIVAC疫苗成本效益模型。对20个连续出生至5岁的儿童队列进行了评估。临床结局包括肺炎球菌肺炎（PP）、肺炎球菌脑膜炎（PM）、肺炎球菌败血症（PS）和任何原因引起的急性中耳炎（AOM）。测量指标包括病例预防、神经后遗症（NS）、听觉后遗症（AS）、死亡和伤残调整生命年（DALY）。还进行了敏感性分析。
对于这20个队列，PCV10和PCV13的净成本分别为3.6326亿美元和4.0826亿美元。PCV10预防了570,273例AOM；79,937例PP；2217例PM；3049例PS；282例NS；173例AS；以及7512例死亡。PCV13预防了419,815例AOM；112,331例PN；3116例PM；4285例PS；404例NS；248例AS；以及10,386例死亡。PCV10避免的DALY为226,370，PCV13为313,119。PCV10节省的治疗成本为3739万美元，PCV13为4722万美元。PCV10每避免一个DALY的成本为1605美元，PCV13为1304美元。敏感性分析显示了类似的结果。PCV13相对于PCV10具有更大的优势。
在秘鲁的背景下，两种肺炎球菌疫苗都具有成本效益。尽管PCV10的疫苗接种净成本较低，但PCV13预防了更多的死亡、肺炎球菌并发症和后遗症。PCV13每预防一个DALY的成本较低。因此，PCV13将是首选政策；如果由于某种原因13价疫苗不可行，PCV10也是合理的（并且相对于现状节省成本）。
