Re-evaluating the impact and cost-effectiveness of pneumococcal conjugate vaccine introduction in 112 low-income and middle-income countries in children younger than 5 years: a modelling study.

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Global Health Pub Date : 2024-09-01 DOI:10.1016/S2214-109X(24)00232-8

Cynthia Chen, Gregory Ang, Katika Akksilp, Jemima Koh, J Anthony G Scott, Andrew Clark, Mark Jit

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Abstract

Background: Streptococcus pneumoniae has been estimated to cause 9·18 million cases of pneumococcal pneumonia, meningitis, and invasive non-pneumonia non-meningitis disease and 318 000 deaths among children younger than 5 years in 2015. We estimated the potential impact and cost-effectiveness of pneumococcal conjugate vaccine (PCV) introduction.

Methods: We updated our existing pseudodynamic model to estimate the impact of 13-valent PCV (PCV13) in 112 low-income and middle-income countries by adapting our previously published pseudodynamic model with new country-specific evidence on vaccine coverage, burden, and post-introduction vaccine impact from WHO-UNICEF estimates of national immunisation coverage and a global burden study. Deaths, disability-adjusted life-years (DALYs), and cases averted were estimated for children younger than 5 years born between 2000 and 2030. We used specific PCV coverage in each country and a hypothetical scenario in which coverage increased to diphtheria-tetanus-pertussis (DTP) levels. We conducted probabilistic uncertainty analyses.

Findings: Using specific vaccine coverage in countries, we estimated that PCV13 could prevent 697 000 (95% credibility interval 359 000-1 040 000) deaths, 46·0 (24·0-68·9) million DALYs, and 131 (89·0-172) million cases in 112 countries between 2000 and 2030. PCV was estimated to prevent 5·3% of pneumococcal deaths in children younger than 5 years during 2000-30. The incremental cost of vaccination would be I$851 (510-1530) per DALY averted. If PCV coverage were increased to DTP coverage in 2020, PCV13 could prevent an additional 146 000 (75 500-219 000) deaths.

Interpretation: The inclusion of real-world evidence from lower-income settings revealed that delays in PCV roll-out globally and low PCV coverage have cost many lives. Countries with delays in vaccine introduction or low vaccine coverage have experienced many PCV-preventable deaths. These findings underscore the importance of rapidly scaling up PCV to achieve high coverage and maximise vaccine impact.

Funding: Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

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重新评估在 112 个低收入和中等收入国家为 5 岁以下儿童接种肺炎球菌结合疫苗的影响和成本效益：一项模型研究。

背景：据估计，2015 年肺炎链球菌可导致 900 万至 1800 万例肺炎球菌肺炎、脑膜炎和侵袭性非肺炎非脑膜炎疾病，并导致 31.8 万名 5 岁以下儿童死亡。我们估算了引入肺炎球菌结合疫苗 (PCV) 的潜在影响和成本效益：方法：我们更新了现有的伪动力学模型，利用世界卫生组织-联合国儿童基金会（WHO-UNICEF）对国家免疫接种覆盖率的估计和一项全球负担研究中有关疫苗覆盖率、负担和引入疫苗后影响的新国别证据，对之前发布的伪动力学模型进行了调整，从而估计了 13 价肺炎球菌结合疫苗（PCV13）在 112 个低收入和中等收入国家的影响。我们估算了 2000 年至 2030 年间出生的 5 岁以下儿童的死亡人数、残疾调整生命年 (DALY) 和避免病例数。我们采用了每个国家 PCV 的具体覆盖率，以及覆盖率提高到白喉-破伤风-百日咳（DTP）水平的假设情景。我们进行了概率不确定性分析：根据各国具体的疫苗覆盖率，我们估计 PCV13 在 2000 年至 2030 年期间可在 112 个国家预防 697 000 例死亡（95% 可信区间为 359 000-1 040 000）、46-0（24-0-68-9）万 DALY 和 1.31（89-0-172）万病例。据估计，在 2000-30 年间，肺炎球菌疫苗可预防 5-3% 的 5 岁以下儿童死于肺炎球菌。每减少 1 DALY 的疫苗接种增量成本为 851 美元（510-1530）。如果 PCV 的覆盖率在 2020 年提高到白喉、破伤风和百日咳的覆盖率，则 PCV13 可额外预防 146 000 例（75 500-219 000 例）死亡：纳入来自低收入环境的真实世界证据表明，全球 PCV 推广的延误和 PCV 覆盖率低已导致许多人丧生。在疫苗推广延误或疫苗覆盖率低的国家，有许多人死于 PCV 可预防的疾病。这些发现强调了迅速推广 PCV 以实现高覆盖率和最大化疫苗影响的重要性：比尔及梅林达-盖茨基金会和疫苗联盟 Gavi。

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来源期刊

Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

44.10

自引率

1.20%

发文量

763

审稿时长

10 weeks

期刊介绍： The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.