Table 6.

Sensitivity analysis results: rank order of three most economically efficient vaccination strategies and associated ICERs

Parameters varied	Assumption	Rank order of most (1) to least (3) economically efficient vaccination strategies [strategy (S) and ICER in US$]
		1	2	3
None	Base case	S5	S6	S7
		23,000	125,000	182,000
Changes in incidence of disease and serotype distribution due to herd protection	Full herd impact	S1	S2	S5
		51,000	77,000	103,000
	50% herd impact	S5	S7
		36,000	266,000
	No herd impact on NBPP	S1	S5	S3
		41,000	50,000	151,000
PPSV23 effectiveness against NBPP	Increase by 10%	S5	S6	S7
		22,000	150,000	173,000
	Decrease base case by 10%	S5	S6	S7
		24,000	106,000	192,000
	Decrease base case by 80%	S5	S6	S7
		32,000	46,000	291,000
	Decrease base case by 100%	S5	S6	S7
		35,000	39,000	337,000
PPSV23 and PCV13 effectiveness waning rates	PPSV23 and PCV13 wane over 10 years	S1	S2	S5
		28,000	31,000	31,000
	PPSV23 wanes over 10 years, PCV13 wanes over 20 years	S5	S6	S7
		20,000	49,000	182,000
	PPSV23 and PCV13 wane over 15 years	S1	S5	S7
		15,000	18,000	328,000

Only non-dominated strategies are shown. Dominated strategies could have been eliminated from consideration due to strong dominance (i.e., a less expensive and more beneficial strategy available), or weak dominance (i.e., a more economically efficient strategy available). Incremental cost-effectiveness ratios are compared as follows: rank 1 vs. no vaccination, rank 2 vs. rank 1, and rank 3 vs. rank 2. Several sensitivity analyses had more than three non-dominated strategies, but only the top three strategies are shown. Full herd impact projections based on changes in adult IPD observed post-introduction of 7-valent pneumococcal conjugate vaccine [17]

ICER, incremental cost-effectiveness ratio; IPD, invasive pneumococcal disease; NBPP, non-bacteremic pneumococcal pneumonia; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine; US$, United States dollars