Table 1.
Base case parameters used in the model.
| Parameter | Value | Source |
|---|---|---|
| Vaccine characteristics | ||
| Efficacy | ||
| … against vaccine-type IPD | 82.5% | Klugman 2003 [18] Kaplan 2013 [21] and Andrews 2014 [22] |
| … against vaccine-type pneumococcal carriage | 82.5% | Assumed same as vaccine-type IPD |
| … against all-cause acute otitis media (PCV13) | 20.2% | Tregnaghi 2014 [24] |
| Coverage (in targeted population) | ||
| … dose one | 98.2% | Ministry of Health, Mongolia. WHO/UNICEF Joint Reporting Form on Immunization, data for 2013 [14] |
| … dose two | 97.9% | Estimated as average of first and third doses |
| … dose three | 97.6% | Ministry of Health, Mongolia. WHO/UNICEF Joint Reporting Form on Immunization, data for 2013 [14] |
| Costs (US$2014) | ||
| Vaccination | ||
| … purchase (PCV13) | $3.30 | Gavi, the Vaccine Alliance [15] |
| … freight (PCV13) | $0.14 | UNICEF Supply Division, Immunization forecast overview, Recommended budget prices for 2014 [16] |
| … buffer stock | 25% | Assumption |
| Hospitalization | ||
| … meningitis | $271.0 | Health Insurance Fund, Mongolia |
| … pneumonia | $160.3 | Pneumonia costing study 2012, Mongolia |
| … invasive NPNM | $271.0 | Same as for meningitis |
| Health centre consultation | ||
| … acute otitis media | $8.3 | Decree by Ministry of Health and Social Health Insurance Office, Mongolia in 2014 |
| Productivity costs | ||
| …female labour force participation rate | 58.4% | National Statistical Office of Mongolia, Ulaanbaatar 2013 [33] |
| …Gross domestic product per capita in 2014 | $4056.4 | World Bank, 2014. World Development Indicators. [34] |
| …Meningitis average hospital stay | 10 days | 2012 hospital records matched by ICD-10 codes from National Center for Health Development, Mongolia |
| …Sepsis (proxy for NPNM) average hospital stay | 9 days | |
| …Pneumonia average hospital stay | 7 days | |
| …Days of work lost from acute otitis media | 1 day | Assumption |
| Out of pocket (OOP) costs | ||
| … meningitis | $145.9 | OOP as percentage of total health care expenditure [35] |
| … pneumonia | $86.3 | Pneumonia costing study 2012, Mongolia |
| … invasive NPNM | $145.9 | OOP as percentage of total health care expenditure [35] |
| … acute otitis media | $4.5 | OOP as percentage of total health care expenditure [35] |
| Proportion of patients who seek care | ||
| … Acute otitis media (health care centre) | 48% | Kazakhstan DHS,1999 [32] |
| … Non-invasive pneumonia | 87% | National Statistics Office, UNICEF. MICS 2010 Summary Report [31] |
| Disease burden | ||
| Incidence (per 100,000) | ||
| …meningitis | 11 | WHO estimate [27], scaled by age-specific incidence from Capeding 2013 [28] |
| …invasive NPNM | 62 | |
| …pneumonia | 1345 | WHO estimate [27], scaled by age-specific incidence from Hasan 2014 [29] |
| Case-fatality risk | ||
| …meningitis | 34.6% | WHO estimate for Mongolia [27] |
| …invasive NPNM | 27.1% | WHO estimate for Mongolia [27] |
| …pneumonia | 5.4% | WHO estimate for Mongolia [27] |
| Disability weights | ||
| … Meningitis (per episode) | 0.62 | “Meningitis, S. pneumoniae” in Mathers 2006 [36] |
| … Pneumonia (per episode) | 0.28 | “Neonatal pneumonia” in Mathers 2006 [36] |
| … NPNM (per episode) | 0.15 | “Meningococcaemia without meningitis” in Mathers 2006 [36] |
| … Otitis media (per episode) | 0.02 | “Otitis media” in Mathers 2006 [36] |
| … Major cognitive difficulties (per year) | 0.46 | “Mental retardation” in Mathers 2006 [36] |
| … Major seizure disorder (per year) | 0.10 | “Seizure” in Mathers 2006 [36] |
| … Major hearing loss (per year) | 0.12 | “Deafness” in Mathers 2006 [36] |
| … Major motor deficit (per year) | 0.38 | “Motor deficit” in Mathers 2006 [36] |
| … Major visual disturbance (per year) | 0.60 | “Blindness” in Mathers 2006 [36] |
| … Major clinical impairment (per year) | 0.10 | “Seizure” in Mathers 2006 [36] |
| Pneumococcal meningitis sequelae risk | ||
| … Major cognitive difficulties | 3.6% | Edmond [37] |
| … Major seizure disorder | 3.0% | Edmond [37] |
| … Major hearing loss (per year) | 8.0% | Edmond [37] |
| … Major motor deficit (per year) | 3.9% | Edmond [37] |
| … Major visual disturbance (per year) | 1.4% | Edmond [37] |
| … Major clinical impairment (per year) | 4.0% | Edmond [37] |
Costs were standardized for 2014 prices, and where necessary, inflated to 2014 prices based on Mongolia’s inflation rate of 15% in 2012 and 8.6% in 2013. IPD: invasive pneumococcal disease; nIPD: non-invasive pneumococcal disease; NPNM: non-pneumonia non-meningitis.