Huang Min, Weaver Jessica P, Elbasha Elamin, Weiss Thomas, Banniettis Natalie, Feemster Kristen, White Meghan, Kelly Matthew S
Merck Research Laboratory, Merck & Co., Inc., Rahway, NJ 07065, USA.
Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA.
Vaccines (Basel). 2024 Sep 12;12(9):1045. doi: 10.3390/vaccines12091045.
This study aimed to evaluate the cost-effectiveness of routine childhood immunization with the 20-valent pneumococcal conjugate vaccine (PCV20) in a four-dose regimen (3 + 1 schedule) versus the 15-valent PCV (PCV15/V114) in a three-dose regimen (2 + 1) in Germany. The study utilized a decision-analytic Markov model to estimate lifetime costs and effectiveness outcomes for a single birth cohort in Germany. The model tracked the incidence of acute pneumococcal infections and long-term pneumococcal meningitis sequelae for both vaccination strategies. The vaccine effectiveness data were derived from published clinical trials and observational studies of PCV7 and PCV13. Indirect effects, such as herd protection and serotype replacement, were included in the model. The model adopted a societal perspective, including direct medical, direct non-medical, and indirect costs. Scenario and sensitivity analyses were performed. In the base case, PCV20 prevented more pneumococcal disease cases and deaths, with an expected gain of 96 quality-adjusted life years (QALYs) compared to V114. However, PCV20 was associated with a total incremental cost of EUR 48,358,424, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 503,620/QALY. Most of the scenario and sensitivity analyses estimated that the ICER for PCV20 exceeded EUR 150,000/QALY. Routine childhood immunization with PCV20 instead of V114 may not be an economically efficient use of healthcare resources in Germany.
本研究旨在评估在德国，20价肺炎球菌结合疫苗（PCV20）四剂次方案（3+1程序）与15价PCV（PCV15/V114）三剂次方案（2+1）用于儿童常规免疫接种的成本效益。该研究利用决策分析马尔可夫模型来估计德国单个出生队列的终身成本和有效性结果。该模型追踪了两种疫苗接种策略下急性肺炎球菌感染的发病率和长期肺炎球菌性脑膜炎后遗症。疫苗有效性数据来源于已发表的PCV7和PCV13的临床试验和观察性研究。模型纳入了间接效应，如群体保护和血清型替换。该模型采用社会视角，包括直接医疗、直接非医疗和间接成本。进行了情景分析和敏感性分析。在基础案例中，与V114相比，PCV20预防了更多肺炎球菌疾病病例和死亡，预期可获得96个质量调整生命年（QALY）。然而，PCV20的总增量成本为48358424欧元，导致增量成本效益比（ICER）为503620欧元/QALY。大多数情景分析和敏感性分析估计，PCV20的ICER超过150000欧元/QALY。在德国，用PCV20而非V114进行儿童常规免疫接种可能并非医疗资源的经济有效利用方式。
