Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Among Adults in the Philippines

Objectives

The Philippine National Immunization Program guidelines recommend using the 23-valent pneumococcal polysaccharide vaccine (PPV23) among senior citizens. We conducted cost-effectiveness analyses to assess the impact of replacing 2-dose PPV23 with PCV13 in all adults aged ≥60 years and expanding the recommendation to include PCV13 for adults aged 18 to 59 years at elevated risk of disease (moderate-/high-risk).

Methods

Lifetime risks and costs of invasive pneumococcal disease, nonbacteremic pneumococcal pneumonia (NBPP), and expected impact of vaccination were projected using a probabilistic cohort model. Base-case analyses compared PCV13 with 2-dose PPV23 (PPV23 + PPV23) among older adults (60-99y). Scenario analyses evaluated PCV13 use among older and moderate-/high-risk adults aged 18 to 59 years versus a combined strategy (18-49 y: no vaccine; 50-59 y: single-dose PPV23; 60-99 y: PPV23 + PPV23). Cost per quality-adjusted life year (QALY) gained was evaluated from healthcare system and societal perspectives (discounting 7%/year). Deterministic and probabilistic sensitivity analyses were conducted.

Results

In the base case, PCV13 instead of PPV23 + PPV23 would reduce cases of invasive pneumococcal disease by 698, NBPP by 915, and deaths by 333 among adults aged 60 to 99 years (N = 10 583 924). With QALYs higher by 848 and net societal (ie, direct + indirect) costs of ₱26.2 million, cost per QALY was ₱30 855. PCV13 was cost-effective in 98.8% of 1000 probabilistic sensitivity analyses simulations in the base-case population. In scenario analyses, PCV13 was also cost-effective (₱423 770/QALY).

Conclusions

Findings support replacing the two-dose PPV23 recommendation with 1 dose of PCV13 in adults aged ≥60 years and expanding the recommendation to include the use of PCV13 among moderate-/high-risk adults aged 18 to 59 years.