Tajima Atsushi, Abe Machiko, Weaver Jessica, Huang Min
MSD K.K., Outcomes Research, Market Access, Tokyo, Japan.
Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA.
J Med Econ. 2023 Jan-Dec;26(1):1034-1046. doi: 10.1080/13696998.2023.2245291.
The 15-valent pneumococcal conjugate vaccine (PCV15 or V114) has recently been approved for pediatric vaccination against pneumococcal diseases (PDs) in Japan. The study aims to evaluate the cost-effectiveness of pediatric vaccination with V114 versus 13-valent PCV (PCV13) in Japan.
The study used a decision analytical Markov model to estimate the cost and effectiveness outcomes for a birth cohort in Japan over a 10-year time horizon. The model tracked the occurrences of acute PD events, including invasive PD (IPD), non-bacteremic pneumococcal pneumonia (NBPP) and pneumococcal acute otitis media (AOM) and the long-term impact of post-meningitis sequalae. Vaccine effectiveness was estimated based on literature and assumptions, and accounted for indirect effects and vaccine waning. The base case took the societal perspective, including both direct and indirect costs, while a healthcare payer perspective was modeled in a scenario analysis. Additional scenario analyses and sensitivity analyses were conducted.
In the base case, V114 was associated with an incremental gain of 24 quality-adjusted life years and a reduction of ¥365,610,955 in total costs compared to PCV13. It was expected to reduce the number of pneumococcal AOM, NBPP, and IPD cases by 1,832, 1,333 and 25, respectively. All scenario analyses and most sensitivity analyses showed that V114 was a dominant strategy compared to PCV13.
Pediatric vaccination with V114 is expected to lead to cost savings and more health benefits compared to PCV13 in Japan from both societal and healthcare payer perspectives. The findings are robust under plausible assumptions and inputs.
15价肺炎球菌结合疫苗（PCV15或V114）最近在日本被批准用于儿童预防肺炎球菌疾病（PDs）。本研究旨在评估在日本使用V114与13价肺炎球菌结合疫苗（PCV13）进行儿童疫苗接种的成本效益。
本研究使用决策分析马尔可夫模型来估计日本一个出生队列在10年时间范围内的成本和效益结果。该模型追踪急性PD事件的发生情况，包括侵袭性PD（IPD）、非菌血症性肺炎球菌肺炎（NBPP）和肺炎球菌急性中耳炎（AOM）以及脑膜炎后遗症的长期影响。疫苗有效性是根据文献和假设估计的，并考虑了间接影响和疫苗效力下降。基础案例采用社会视角，包括直接和间接成本，而在情景分析中模拟了医疗保健支付者视角。还进行了额外的情景分析和敏感性分析。
在基础案例中，与PCV13相比，V114带来了24个质量调整生命年的增量收益，总成本降低了365,610,955日元。预计它将分别减少肺炎球菌AOM、NBPP和IPD病例1,832例、1,333例和25例。所有情景分析和大多数敏感性分析表明，与PCV13相比，V114是一种占优策略。
从社会和医疗保健支付者的角度来看，在日本，与PCV13相比，使用V114进行儿童疫苗接种预计将节省成本并带来更多健康益处。在合理的假设和输入下，研究结果是可靠的。
