Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Medicine, University of Cape Town, Cape Town, South Africa.
PLoS One. 2020 Jan 29;15(1):e0227945. doi: 10.1371/journal.pone.0227945. eCollection 2020.
Streptococcus pneumoniae (pneumococcus) remains an important cause of morbidity and mortality. Pneumococcal vaccination is part of the South African pediatric public immunization program but the potential cost-effectiveness of such an intervention for adults is unknown. This study aimed to compare the cost-effectiveness of two widely used pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) in South African adults, 18 years and older. Four analyses were carried out in a) both the private and public health care sectors; and b) for the HIV-infected population alone and for the total mixed population (all HIV-infected and -uninfected people). A previously published global pharmacoeconomic model was adapted and populated to represent the South African adult population. The model utilized a Markov-type process to depict the lifetime clinical and economic outcomes of patients who acquire pneumococcal disease in 2015, from a societal perspective. Costs were sourced in South African rand and converted to US dollar (USD). The incremental cost divided by the incremental effectiveness (expressed as quality-adjusted life years gained) represented the incremental cost-effectiveness ratio for PCV13 compared to PPSV23. Results indicated that the use of PCV13 compared to PPSV23 is highly cost-effective in the public sector cohorts with incremental cost-effectiveness ratios of $771 (R11,106)/quality-adjusted life year and $956 (R13,773)/quality-adjusted life year for the HIV-infected and mixed populations, respectively. The private sector cohort showed similar highly cost-effective results for the mixed population (incremental cost-effectiveness ratio $626 (R9,013)/quality-adjusted life year) and the HIV-infected cohort (dominant). In sensitivity analysis, the model was sensitive to vaccine price and effectiveness. Probabilistic sensitivity analyses found predominantly cost-effective ICERs. From a societal perspective, these findings provide some guidance to policy makers for consideration and implementation of an immunization strategy for both the public and private sector and amongst different adult patient pools in South Africa.
肺炎链球菌（肺炎球菌）仍然是发病率和死亡率的重要原因。肺炎球菌疫苗接种是南非儿科公共免疫计划的一部分，但这种干预措施对成年人的潜在成本效益尚不清楚。本研究旨在比较两种广泛使用的肺炎球菌疫苗：肺炎球菌结合疫苗（PCV13）和肺炎球菌多糖疫苗（PPSV23）在南非成年人中的成本效益，年龄在 18 岁及以上。在以下两种情况下进行了四项分析：a）私人和公共医疗保健部门；b）仅针对 HIV 感染者人群和总混合人群（所有 HIV 感染者和未感染者）。先前发表的全球药物经济学模型经过改编并应用于代表南非成年人口的模型中。该模型利用马尔可夫型过程来描述 2015 年从社会角度获得肺炎球菌病的患者的终生临床和经济结局。成本来源于南非兰特，并转换为美元（USD）。增量成本除以增量效果（表示为获得的质量调整生命年）代表 PCV13 与 PPSV23 相比的增量成本效益比。结果表明，与 PPSV23 相比，PCV13 在公共部门队列中具有很高的成本效益，增量成本效益比分别为每获得一个质量调整生命年 771 美元（11106 兰特）和每获得一个质量调整生命年 956 美元（13773 兰特），用于 HIV 感染者和混合人群。私营部门队列对混合人群（增量成本效益比为每获得一个质量调整生命年 626 美元（9013 兰特））和 HIV 感染者队列（占主导地位）显示出类似的高度成本效益结果。在敏感性分析中，该模型对疫苗价格和效果敏感。概率敏感性分析发现主要是成本效益高的 ICERs。从社会角度来看，这些发现为决策者提供了一些指导，以考虑并实施南非公共和私营部门以及不同成年患者群体的免疫策略。
