Ansaldi Filippo, Pugh Sarah, Amicizia Daniela, Di Virgilio Roberto, Trucchi Cecilia, Orsi Andrea, Zollo Alessandro, Icardi Giancarlo
Department of Health Sciences, University of Genoa, 16132 Genoa, Italy.
IRCCS San Martino University Hospital, 16132 Genoa, Italy.
Pathogens. 2020 Jan 22;9(2):76. doi: 10.3390/pathogens9020076.
: Invasive and non-invasive pneumococcal diseases are significant health and economic burdens, especially in children and the elderly. Italy included the 7-valent (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the National Immunization Program in 2007 and 2010, respectively, allowing a dramatic reduction in the burden of pneumococcal disease. In the era of budget constraints, decision-makers may consider switching from the higher-valent, more costly PCV13, to the lower-cost PCV10. This study estimated the potential public health and economic impact of changing vaccine programs from PCV13 to PCV10 in Italy. : A decision-analytic forecasting model estimated the impact of PCV programs. Real-world surveillance data were used to forecast serotype distribution and disease incidence among children and the elderly over a specified 5-year time horizon. Costs and outcomes included estimates of cases and deaths avoided, quality-adjusted life years (QALYs) gained, and total costs from a payer perspective, discounted at an assumed rate of 3.0%, and robustness validated through several scenarios and sensitivity analyses. : A switch from PCV13 to PCV10 would increase invasive pneumococcal disease (IPD) cases by 59.3% (4317 cases) over a 5-year horizon, primarily due to serotypes 3 and 19A. Pneumonia increased by 8.3% and acute otitis media (AOM) by 96.1%. Maintaining a PCV13 program would prevent a total incremental 531,435 disease cases (1.02M over a 10-year time horizon) and 641 deaths due to invasive pneumococcal disease (IPD), with €23,642 per QALY gained over 5 years versus PCV10. One-way and probabilistic sensitivity analyses showed that a PCV13-based program remained cost-effective in 99.7% of the simulations in Italy as parameters varied within their plausible range; percent vaccinated had the most impact. : Maintaining the PCV13 strategy would provide substantial public health and economic benefits in Italy and is cost-effective. Switching from PCV13 to PCV10 would increase the incidence of pneumococcal disease primarily linked to re-emergence of serotypes 3 and 19A.
侵袭性和非侵袭性肺炎球菌疾病是重大的健康和经济负担，尤其在儿童和老年人中。意大利分别于2007年和2010年将7价（PCV7）和13价肺炎球菌结合疫苗（PCV13）纳入国家免疫规划，使肺炎球菌疾病负担大幅降低。在预算紧张的时代，决策者可能会考虑从更高价、更昂贵的PCV13转向成本更低的PCV10。本研究估计了意大利疫苗计划从PCV13改为PCV10对公共卫生和经济的潜在影响。：一个决策分析预测模型估计了PCV计划的影响。利用真实世界监测数据预测特定5年时间范围内儿童和老年人的血清型分布和疾病发病率。成本和结果包括避免的病例和死亡估计数、获得的质量调整生命年（QALY）以及从支付方角度计算的总成本，按3.0%的假定贴现率贴现，并通过多种情景和敏感性分析验证稳健性。：从PCV13改为PCV10将在5年时间内使侵袭性肺炎球菌疾病（IPD）病例增加59.3%（4317例），主要原因是血清型3和19A。肺炎增加8.3%，急性中耳炎（AOM）增加96.1%。维持PCV13计划将总共预防531435例新增疾病病例（10年时间范围内为102万例）以及641例因侵袭性肺炎球菌疾病（IPD）导致的死亡，与PCV10相比，5年内每获得一个QALY的成本为23642欧元。单因素和概率敏感性分析表明，在意大利，随着参数在合理范围内变化，基于PCV13的计划在99.7%的模拟中仍具有成本效益；接种率的影响最大。：在意大利维持PCV13策略将带来巨大的公共卫生和经济效益，且具有成本效益。从PCV13改为PCV10将增加肺炎球菌疾病发病率，主要与血清型3和19A的再度出现有关。
