Economic evaluation of universal 7-valent pneumococcal conjugate vaccination in Taiwan: A cost-effectiveness analysis

Pneumococcal diseases caused by Streptococcus pneumoniae can lead to significant morbidity and mortality in young infants and the elderly. The seven-valent pneumococcal conjugate vaccine (PCV7) has been available on the private market in Taiwan since October 2005. To date, there has not been any cost-effectiveness analysis (CEA) of PCV7 in Taiwan. A pharmacoeconomic model populated with local parameters is needed for vaccine decision-making. The aim of the study was to provide a CEA of PCV7 in Taiwan and explore the impact of herd effect and indirect cost on the findings of CEA. Methods: A decision analytic model was populated with local epidemiological and economic data to simulate the expected clinical and economic outcomes from a hypothetical vaccinated birth cohort of 191,310 infants compared to no vaccination over a 10-year time horizon. To explore the impact of herd effect, results were presented with and without herd effect. Moreover, the study was conducted from both payer and societal perspectives to examine the impact of indirect cost. One-way sensitivity analyses were performed to evaluate model robustness. The cost-effectiveness of a reduced three-dose schedule was also estimated. Results: PCV7 vaccination could prevent 1281 cases of invasive pneumococcal diseases, 178,145 cases of all-cause hospitalized pneumonia, 69,962 cases of all-cause acute otitis media, and 981 deaths over a 10-year time horizon. The vaccination program with an annual cost of NT$1,950.5 million could lead to 15.4% reduction in direct medical costs of NT$6,010 million and 64.1% reduction in indirect costs of NT$9,467 million. The vaccination with a four-dose schedule would lead to an incremental cost of NT$1,183,028 per life-year gained from the payer perspective and NT$619,862 per life-year gained from the societal perspective. Conclusion: Taking herd effect and indirect costs into account, PCV7 vaccination is cost-effective in Taiwan. Further pharmacoeconomic model should include herd effect in CEA of infectious disease research