Huang Liping, McDade Cheryl L, Perdrizet Johnna E, Wilson Michele R, Warren Sophie A, Nzenze Susan, Sewdas Renilla
Pfizer Inc., 235 East 42nd Street, New York, NY, 10017, USA.
RTI Health Solutions, PO Box 12194, Research Triangle Park, NC, USA.
Infect Dis Ther. 2023 Mar;12(3):933-950. doi: 10.1007/s40121-023-00767-4. Epub 2023 Feb 12.
Pneumococcal disease, which presents a substantial health and economic burden, is prevented through pneumococcal vaccination programs. We assessed the impact of switching from a 13-valent-based (PCV13) to lower 10-valent-based (PCV10-GlaxoSmithKline [GSK] or PCV10-Serum Institute of India [SII]) or higher-valent (PCV15 or PCV20) vaccination programs in South Africa.
A previously published decision-analytic model was adapted to a South African setting. Historical invasive pneumococcal disease (IPD) incidence data were used to project IPD incidence over time for each vaccination program on the basis of serotype coverage. Historical incidence (IPD, pneumonia, otitis media), mortality, costs, and utilities were obtained from the published literature. Cases of disease, direct medical costs (i.e., vaccination, IPD, pneumonia, and otitis media costs) (in 2022 South African rands), life-years, quality-adjusted life-years (QALY), and incremental cost per QALY were estimated over a 5- and 10-year horizon for PCV13 and the PCV10 vaccines. Additionally, a public health impact analysis was conducted comparing PCV13, PCV15, and PCV20.
Continuing use of PCV13 would substantially reduce disease incidence over time compared with switching to either of the PCV10 lower-valent vaccines. Cases of IPD were reduced by 4.22% and 34.70% when PCV13 was compared to PCV10-GSK and PCV10-SII, respectively. PCV13 was also found to be cost saving over 5- and 10-year time horizons compared with PCV10-SII and to be cost-effective over a 5-year time horizon and cost-saving over a 10-year time horizon compared with PCV10-GSK. PCV20 was consistently estimated to prevent more cases than the PCV10 vaccines, PCV13, or PCV15.
Switching from a higher-valent to a lower-valent vaccine may lead to disease incidence re-emergence caused by previously covered serotypes. Maintaining PCV13 was estimated to improve public health further by averting additional pneumococcal disease cases and saving more lives and also to reduce total costs in most scenarios. Higher-valent PCVs can achieve the greatest public health impact in the pediatric vaccination program in South Africa.
肺炎球菌疾病带来了巨大的健康和经济负担，可通过肺炎球菌疫苗接种计划来预防。我们评估了在南非从基于13价（PCV13）的疫苗接种计划转向较低的基于10价（PCV10 - 葛兰素史克[GSK]或PCV10 - 印度血清研究所[SII]）或更高价（PCV15或PCV20）疫苗接种计划的影响。
将先前发表的决策分析模型应用于南非的情况。利用历史侵袭性肺炎球菌疾病（IPD）发病率数据，根据血清型覆盖率预测每个疫苗接种计划随时间的IPD发病率。历史发病率（IPD、肺炎、中耳炎）、死亡率、成本和效用数据来自已发表的文献。在5年和10年的时间范围内，估计了PCV13和PCV10疫苗的疾病病例、直接医疗成本（即疫苗接种、IPD、肺炎和中耳炎成本）（以2022年南非兰特计）、生命年、质量调整生命年（QALY）以及每QALY的增量成本。此外，还进行了一项公共卫生影响分析，比较了PCV13、PCV15和PCV20。
与改用任何一种PCV10低价疫苗相比，继续使用PCV13随着时间推移将大幅降低疾病发病率。将PCV13与PCV10 - GSK和PCV10 - SII分别比较时，IPD病例数分别减少了4.22%和34.70%。还发现，与PCV10 - SII相比，PCV13在5年和10年的时间范围内节省成本；与PCV10 - GSK相比，PCV13在5年的时间范围内具有成本效益，在10年的时间范围内节省成本。始终估计PCV20预防的病例数比PCV10疫苗、PCV13或PCV15更多。
从高价疫苗转向低价疫苗可能导致先前覆盖血清型引起的疾病发病率再次出现。据估计，维持PCV13通过避免额外的肺炎球菌疾病病例、挽救更多生命进一步改善公共卫生，并且在大多数情况下还能降低总成本。更高价的PCV在南非的儿童疫苗接种计划中可实现最大的公共卫生影响。
