Mueller Peter P, Tajima Atsushi, Cassell Kelsie, Matsuki Taizo, Cossrow Nicole, Yi Zinan, Johnson Kelly D, Owusu-Edusei Kwame
Merck & Co., Inc, Rahway, NJ, USA.
Outcomes Research, MSD K.K., Tokyo, Japan.
J Med Econ. 2025 Dec;28(1):136-145. doi: 10.1080/13696998.2024.2445429. Epub 2025 Jan 2.
This study analyzed the health and economic impact of the 21-valent pneumococcal conjugate vaccine (V116) and the 20-valent pneumococcal conjugate vaccine (PCV20), as well as their relative cost-effectiveness, in Japanese adults aged 65 years using a delta pricing approach.
A Markov model was employed to simulate the movement of the Japanese population among four health states: healthy, pneumococcal disease (consisting of invasive pneumococcal disease [IPD] with or without meningitis and non-bacteremic pneumococcal pneumonia [NBPP]), post-meningitis sequelae, and death. The model was populated with publicly available demographic and epidemiologic data, stratified by risk level. Pneumococcal serotype distribution and vaccine effectiveness, as well as direct and indirect treatment costs and health-related utilities, were derived from published sources. The model used a lifetime horizon and 2% discounting of costs and life-years. Costs were adjusted to 2023 values in Japanese yen (¥). Outcomes were cases and deaths, life-years and quality-adjusted life-years (QALYs), vaccination and treatment costs, and incremental cost-effectiveness ratios. The range over which V116 was cost-saving and cost-effective was determined.
Compared to PCV20, V116 averted an additional 28 cases of IPD, 918 cases of NBPP, 5 deaths from IPD, and 51 deaths from NBPP over the lifetime of a single age 65 cohort. Life-years and QALYs gained were 1,019 and 642, respectively, relative to PCV20; V116 saved ¥733 million in direct medical costs and ¥557 million in indirect costs, compared to PCV20. V116 was found to be cost-saving at price premiums up to ¥1,322 (payer perspective) or ¥2,327 (societal perspective) and remained below a willingness-to-pay threshold of ¥5 million/QALY for premiums up to ¥7,113 (payer perspective) or ¥8,117 (societal perspective).
V116 is projected to provide more population health benefits in Japan than PCV20, and to be cost-effective at a variety of price premiums.
本研究采用差值定价法分析了21价肺炎球菌结合疫苗（V116）和20价肺炎球菌结合疫苗（PCV20）对65岁日本成年人的健康和经济影响及其相对成本效益。
采用马尔可夫模型模拟日本人群在四种健康状态之间的转变：健康、肺炎球菌疾病（包括伴或不伴脑膜炎的侵袭性肺炎球菌疾病[IPD]和非菌血症性肺炎球菌肺炎[NBPP]）、脑膜炎后遗症和死亡。该模型采用公开的人口统计学和流行病学数据，并按风险水平分层。肺炎球菌血清型分布和疫苗效力，以及直接和间接治疗成本及与健康相关的效用，均来源于已发表的资料。该模型采用终生视角，并对成本和生命年进行2%的贴现。成本按2023年日元（¥）价值进行调整。结果包括病例数和死亡数、生命年和质量调整生命年（QALY）、疫苗接种和治疗成本以及增量成本效益比。确定了V116具有成本节约效益和成本效益的范围。
与PCV20相比，在一个65岁队列的终生期间，V116额外避免了28例IPD、918例NBPP、5例IPD死亡和51例NBPP死亡。相对于PCV20，获得的生命年和QALY分别为1019和642；与PCV20相比，V116节省了7.33亿日元的直接医疗成本和5.57亿日元的间接成本。研究发现，在价格溢价高达1322日元（支付方视角）或2327日元（社会视角）时，V116具有成本节约效益，在价格溢价高达7113日元（支付方视角）或8117日元（社会视角）时，其成本效益仍低于500万日元/QALY的支付意愿阈值。
预计V116在日本比PCV20能为更多人群带来健康益处，并且在各种价格溢价下都具有成本效益。
