Cost-effectiveness of introducing the pneumococcal conjugate vaccine for children under 5 years in the Islamic Republic of Iran

Background: Pneumococcal disease caused by Streptococcus pneumoniae results in considerable mortality and morbidity. Pneumococcal conjugate vaccines (PCV), such as PCV-13, can prevent invasive pneumococcal disease and avoid disability and death. The cost of introducing PCV-13 in childhood immunization schedules should be assessed against the cost of pneumococcal diseases for each community. Aims: This study aimed to evaluate the cost-effectiveness of introducing PCV-13 in the national immunization programme for children under 5 years in the Islamic Republic of Iran. Methods: The TRIVAC decision support model was used to estimate total costs of introducing PCV-13 and the disability-adjusted life years (DALYs) averted. The main pneumococcal diseases were considered-pneumonia, meningitis, acute otitis media, and non-pneumonia, non-meningitis infections-in terms of hospital admissions, outpatient visits and deaths. Local data were used to estimate costs. Results: Pneumococcal disease is estimated to affect 18 713 211 children under 5 years (519 412 pneumonia,18 148 II6 acute otitis media, 6884 meningitis, and 38 799 non-pneumonia, non-meningitis) in 10 years (2014-2023) without use of the vac- cine. Introduction of PCV-13 would prevent 4 900 084 cases of pneumococcal disease (190 849 pneumonia, 4 692 450 acute otitis media, 2529 meningitis, and 14 256 non-pneumonia, non-meningitis). Pneumococcal infection would cause 287 950 hospital admissions and 29 399 deaths; vaccination could avert 105 802 hospital admissions and 9997 deaths. The incremental cost-effectiveness was estimated to be USs 1890 and USs 1538 per averted DALY for the government and society respectively. Conclusion: According to WHO-recommended thresholds for interpreting cost-effectiveness, introduction of PCV-13 for children under 5 years in the Islamic Republic of Iran would be cost-effective.