Removing 1 PCV Dose Might Save $429 Million

Larry Hand

July 01, 2013

Changing the schedule from 3 to 2 primary pneumococcal conjugate vaccine (PCV) doses, but keeping a booster dose, might save a gross of $500 million for a birth cohort of 4.3 million children, according to an article published online July 1 in Pediatrics.

The savings would be reduced to $429 million after accounting for increases in medical and nonmedical costs of $79 million. When potential fatal and nonfatal outcomes are considered, savings would range from $143,000 to $4 million for each additional quality-adjusted life-year (QALY), the researchers report. However, they suggest the additional medical costs might be mitigated by increased vaccine coverage.

Charles Stoecker, PhD, from the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues used a probabilistic model to calculate the potential savings.

The current PCV 13-valent regiment (PCV13) is highly effective but is also the most expensive vaccine on the routine US pediatric schedule, at ~$100 a dose. Introduction of the PCV7 vaccine in 2000 was associated with significant mortality cost reductions, and introduction of the PCV13 regimen in 2010 "holds promise for further reductions," the researchers write.

To save costs, however, many countries have adopted and continue to support a 3-dose schedule in lieu of the 4 doses (3 primary and 1 booster) currently recommended in the US schedule.

The researchers used Monte Carlo simulation in spreadsheet-based software to project cost savings for a birth cohort equivalent to the 2010 US birth cohort of 4,312,097, combining those data with the most recent life expectancy and background mortality estimates by age from 2007. They tracked invasive pneumococcal disease (IPD) incidence in the model through age 10 years.

They modeled PCV13 effect on PCV13-serotype IPD for all-cause mortality and all-cause otitis media for the 3+1 and 2+1 dose schedules. They found that removing the third primary dose from the schedule could increase IPD cases by 44, deaths by 2.5, pneumonia hospitalizations by about 1500, outpatient-treated pneumonia cases by 10,000, tympanostomy tube replacements by 2300, and otitis media cases by 261,000.

"Our Monte Carlo simulations indicated that 2+1 saved more than $100,000 per QALY lost in 99% of simulations and saved >$450,000 per QALY lost in 55% of simulations," the researchers write. "We also found that when a change to a 2+1 schedule was combined with a coverage expansion from the current 83.3% to 86.0% there were (on net) no additional deaths."

In an accompanying editorial, Emmanuel B. Walter, MD, MPH, and Dennis A. Clements, MD, PhD, MPH, from the Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, write, "Ironically, as the authors point out, the majority of cost savings for PCV are related to reductions in costs for treating very frequently occurring infections, such as otitis media, rather than less commonly occurring but more serious life-threatening IPD. Before contemplating a switch to a 3-dose series, it is important to remember the most serious diseases that PCV prevents and [ensure] that the dosing schedule ultimately chosen is up to the challenge of preventing these infections."

The authors have disclosed no relevant financial relationships. Dr. Walter has received funding from Pfizer to conduct research studies. Dr. Clements has disclosed no relevant financial relationships.

Pediatrics. Published online July 1, 2013. Abstract


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