Cost-Effectiveness Analysis of Pneumococcal Conjugate Vaccine in Taiwan: A Transmission Dynamic Modeling Approach

Objectives: Streptococcus pneumoniae causes significant morbidity and mortality worldwide. Static pharmacoeconomic models have been used to conduct pharmacoeconomic analyses of pediatric pneumococcal conjugate vaccination programs. The objective of this study was to develop a transmission dynamic model to evaluate the cost-effectiveness of a 13-valent pneumococcal conjugate vaccine (PCV13) in Taiwan. Methods: An age-structured transmission dynamic model was populated with parameters from the Taiwanese National Health Insurance Research Database and publicly available sources to evaluate the clinical and economic impact of PCV13. Sensitivity analyses were performed to explore model uncertainties. Results: In the basecase analysis, four-dose scheduled universal infant PCV13 vaccination will prevent 5112 cases of invasive pneumococcal diseases, 535,607 cases of all-cause hospitalized pneumonia, 726,986 cases of acute otitis media, and 420 deaths over a 10-year time horizon since 2009. The four-dose vaccination program is estimated to yield an incremental cost-effectiveness ratioof US$38,045 and US$18,299 from payer and societal perspectives. One-way sensitivity analyses indicated that the incremental cost-effectiveness ratio is most sensitive to vaccine price. The 95% confidence interval of the incremental cost-effectiveness ratio was US$10,186 to US$34,563 by multivariate probabilistic sensitivity analyses in the societal perspective. Conclusions: With a World Health Organization-recommended cost-effectiveness threshold, the PCV13 vaccination program would be cost-effective in Taiwan. To circumvent the lack of long-term real data, a transmission dynamic model is informative to decision makers on evaluating the long-term cost-effectiveness of PCV13.