a Department of Biomedical Sciences , University of Sassari , Sassari , Italy.
b AdRes , Turin , Italy.
Hum Vaccin Immunother. 2017 Oct 3;13(10):2307-2315. doi: 10.1080/21645515.2017.1343773. Epub 2017 Jul 12.
Pneumococcal diseases are associated with a significant clinical and economic burden. The 7-valent pneumococcal conjugate vaccine (PCV-7) has been used for the immunization of newborns against invasive pneumococcal diseases (IPD) in Italy while now, the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and the 13-valent pneumococcal conjugate vaccine (PCV-13) are available. The aim of this analysis was to compare the estimated health benefits, cost and cost-effectiveness of immunization strategies vs. non-vaccination in Italy using the concept of overall vaccine effectiveness. A published Markov model was adapted using local data wherever available to compare the impact of neonatal pneumococcal vaccination on epidemiological and economic burden of invasive and non-invasive pneumococcal diseases, within a cohort of newborns from the Italian National Health Service (NHS) perspective. A 18-year and a 5-year time horizon were considered for the base-case and scenario analysis, respectively. PHiD-CV and PCV-13 are associated with the most important reduction of the clinical burden, with a potential marginal advantage of PHiD-CV over PCV-13. Compared with no vaccination, PHiD-CV is found on the higher limit of the usually indicated willingness to pay range (30,000 - 50,000€/quality-adjusted life year [QALY] gained), while the incremental cost-effectiveness ratio (ICER) for PCV-13 is slightly above. Compared with PCV-13, PHiD-CV would provide better health outcomes and reduce costs even at parity price, solely due to its differential effect on the incidence of NTHi acute otitis media (AOM). The analysis on a shorter time horizon confirms the direction of the base-case.
肺炎球菌病与重大的临床和经济负担相关。7 价肺炎球菌结合疫苗（PCV-7）已在意大利被用于新生儿针对侵袭性肺炎球菌病（IPD）的免疫接种，而现在，肺炎球菌型别不可分型流感嗜血杆菌蛋白 D 结合疫苗（PHiD-CV）和 13 价肺炎球菌结合疫苗（PCV-13）也可获得。本分析旨在使用总体疫苗效力的概念，比较意大利免疫接种策略与不接种疫苗的情况下的估计健康获益、成本和成本效益。使用当地可用的数据，对发表的马尔可夫模型进行了调整，以比较新生儿肺炎球菌疫苗接种对侵袭性和非侵袭性肺炎球菌病的流行病学和经济负担的影响，该模型是从意大利国家卫生服务（NHS）的角度针对新生儿队列进行比较。在基本情况下和情景分析中分别考虑了 18 年和 5 年的时间范围。PHiD-CV 和 PCV-13 与临床负担的最大减少相关，并且 PHiD-CV 与 PCV-13 相比具有潜在的边际优势。与不接种疫苗相比，PHiD-CV 处于通常表明的支付意愿范围（30000-50000 欧元/质量调整生命年[QALY]）的上限，而 PCV-13 的增量成本效益比（ICER）略高。与 PCV-13 相比，由于其对 NTHi 急性中耳炎（AOM）发病率的差异影响，PHiD-CV 仅通过其更高的价格就可以提供更好的健康结果并降低成本。在更短的时间范围内进行的分析确认了基本情况的方向。
