Pneumococcal vaccines: search for an optimal agent
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Pneumococcal vaccines: search for an optimal agent – Nitin Joshi – Six economic analyses focussing on pneumococcal vaccines and showing results in favour of 10-valent Haemophilus influenzae pneumococcal vaccine, followed by pneumococcal 13-valent CRM197 vaccine conjugate, were presented at the 12th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research [ISPOR; Paris, France; October 2009]. Pneumococcal diseases, caused by Streptococcus pneumoniae, are a major health problem all over the world. Invasive pneumococcal infections include pneumonia, meningitis and febrile bacteraemia, whereas noninvasive pneumococcal infections include otitis media, bronchitis and sinusitis. Pneumococcal infections may affect people of any age, however, the majority of infections are observed in young children and elderly patients. Vaccination is the mainstay of prevention against pneumococcal infections. There are two types of pneumococcal vaccines: pneumococcal polysaccharide vaccines and pneumococcal conjugate vaccine, the latter of which are considered more efficient. The following four conjugate vaccines were the focus of six studies presented at EISPOR: 10-valent Haemophilus influenzae pneumococcal vaccine (PHiDCV), pneumococcal 13-valent CRM197 vaccine conjugate (PCV13), pneumococcal 10-valent vaccine conjugate (PCV10) and pneumococcal 7-valent CRM197 vaccine conjugate (PCV7).1,2,3,4,5,6
PCV13 ahead of PCV7 and PCV10. . . Three studies compared the cost effectiveness of PCV13, PCV7 and PCV10 in the UK,1 Germany2 and Canada.3 The first study used a static cohort model to estimate the cost effectiveness of PCV13 and PCV10, compared with PCV7, for the vaccination of children in the UK.1 In addition to vaccination with PCV7, PCV13 vaccination annually reduced the incidence of invasive pneumococcal disease (IPD) by 888 cases, prevented 23 deaths, increased QALYs gained by 611, increased the number of life years gained by 509 and reduced medical costs by £5.2 million; the respective results for PCV10 vaccination were 573 cases, 16 deaths, 375 QALYs, 343 life years and £3.3 million. According to the UK-based researchers, "PCV13 vaccination in the UK will be more effective than PCV10 in reducing the burden of pneumococcal disease when compared to PCV7". The second study used a Markov model to evaluate the cost effectiveness of switching vaccination from PCV7 to PCV13 in German children.2 In the base case with a 3+1 regimen and a vaccine uptake of 90%, vaccination with PCV7, PCV10 and PCV13 reduced IPD cases on a population level by 4593, 5305 and 6092, respectively. The results showed PCV13 vaccination to be a dominant strategy over vaccination with PCV7 or PCV10. Depending on the vaccine uptake, the validated effect of conjugated vaccines on nasopharyngeal carriage helped PCV13 to prevent €1.40 (90% uptake) and €1.70 (80% uptake) for every Euro spent on vaccination. The third study used a decision-analytic model, constructed from a payer perspective, to estimate the cost effectiveness of PCV13
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