Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Thailand.
Vaccine. 2019 Jul 26;37(32):4551-4560. doi: 10.1016/j.vaccine.2019.06.015. Epub 2019 Jul 4.
A previous cost-effectiveness analysis (CEA) showed that Pneumococcal Conjugate Vaccine (PCV) 10 and PCV13 were not cost-effective for universal immunization among children in Thailand. Given recent changes in the evidence of efficacy, herd effects and price, a CEA of PCVs should be revisited. This study aimed to determine the cost-effectiveness of PCV10 and PCV13 compared to no PCV vaccination in Thai children.
A Markov model was developed under a societal perspective with a lifetime horizon. Inputs were derived from a comprehensive literature review. Costs were calculated using the Thai National Electronic Database and converted to the year 2017 value. All costs and outcomes were discounted at a rate of 3%. The findings were reported as incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed. A cost-effectiveness acceptability curve was generated with the cost-effectiveness threshold of 160,000 THB/QALY.
Base-case analysis of 2 + 1 dose schedule and five-year protection, with no consideration of herd effect showed that ICER for PCV10 was 170,437 THB/QALY, while ICER for PCV13 was 73,674 THB/QALY. With consideration of herd effect, both PCV10 and PCV13 had lower costs and higher QALYs compared to no PCV vaccination. Based on our probabilistic sensitivity analysis at willingness-to-pay of 160,000 THB/QALY, PCV13 had 93% of being cost-effective, while 4.7% and 2.3%, for PCV10 and no PCV vaccination, respectively.
At current prices, PCV13 is cost-effective, while PCV10 is not cost-effective in Thailand. When considering herd-effect, both PCV10 and PCV13 are cost-effective.
先前的成本效益分析（CEA）表明，肺炎球菌结合疫苗（PCV）10 型和 PCV13 型对泰国儿童的普遍免疫不具有成本效益。鉴于最近疫苗疗效、群体效应和价格方面的证据发生了变化，应对 PCV 进行重新评估。本研究旨在确定与不接种 PCV 相比，PCV10 型和 PCV13 型在泰国儿童中的成本效益。
采用终生视角，从社会角度出发，建立了一个马尔可夫模型。研究采用了全面的文献综述，获取了输入数据。使用泰国国家电子数据库计算成本，并转换为 2017 年的价值。所有成本和结果均按 3%的贴现率贴现。研究结果以每获得一个质量调整生命年（QALY）增加的增量成本效益比（ICER）表示，单位为泰铢（THB）。进行了敏感性分析。绘制了成本效益接受曲线，成本效益阈值为 160,000 THB/QALY。
在不考虑群体效应的情况下，2+1 剂接种方案和 5 年保护期的基础分析显示，PCV10 的 ICER 为 170,437 THB/QALY，而 PCV13 的 ICER 为 73,674 THB/QALY。考虑到群体效应，与不接种 PCV 相比，PCV10 和 PCV13 的成本更低，QALY 更高。根据我们在支付意愿为 160,000 THB/QALY 时的概率敏感性分析，PCV13 有 93%的可能性具有成本效益，而 PCV10 和不接种 PCV 的可能性分别为 4.7%和 2.3%。
在当前价格下，PCV13 具有成本效益，而 PCV10 则不然。考虑到群体效应，PCV10 和 PCV13 均具有成本效益。
