Table 3.
Incremental outcomes of PCV13 compared to no vaccination over thirty years.
| Direct and indirect population effects (base case)a |
Direct population effects onlyb |
||||
|---|---|---|---|---|---|
| No vaccination with PCV | Vaccination with PCV13 | Difference: Vaccination with PCV13 vs. no PCV vaccination | Vaccination with PCV13 | Difference: Vaccination with PCV13 vs. no PCV vaccination | |
| Number of children vaccinated with 3 doses | 0 | 1.9 mil | 1.9 mil | 1.9 mil | 1.9 mil |
| Total vaccination cost (undiscounted) | $0 | $19 mil | $19 mil | $19 mil | $19 mil |
| Freight, administration cost (undiscounted) | $0 | $5.6 mil | $5.6 mil | $5.6 mil | $5.6 mil |
| Health care costs (undiscounted) | $51.7 mil | $36.6 mil | −$15.1 mil | $40.0 mil | −$11.8 mil |
| Societal costs (undiscounted) | $54.6 mil | $40.5 mil | −$14.2 mil | $44.3 mil | −$10.4 mil |
| IPD cases | 17,700 | 10,800 | −6,890 | 10,040 | −7,700 |
| Non-IPD pneumonia cases | 217,000 | 132,000 | −85,200 | 158,000 | −58,900 |
| Acute otitis media cases | 4,360,000 | 3,940,000 | −417,000 | 3,940,000 | −417,000 |
| Deaths | 15,200 | 9,240 | −5,950 | 10,300 | −4,900 |
| DALYs lost (undiscounted) | 548,000 | 364,000 | −184,000 | 378,000 | −170,000 |
| DALYs lost (discounted) | 358,000 | 237,000 | −121,000 | 250,000 | −108,000 |
| Total costs with productivity (undiscounted) | $106 mil | $102 mil | −$4.72 mil | $109 mil | $2.44 mil |
| Total costs with productivity (discounted) | $ 69.5 mil | $66.5 mil | −$2.96 mil | $71.5 mil | $2.02 mil |
| Total costs without productivity (undiscounted) | $51.7 mil | $61.2 mil | $9.46 mil | $64.5 mil | $12.8 mil |
| Total costs without productivity (discounted) | $33.8 mil | $40.0 mil | $6.25 mil | $42.4 mil | $8.62 mil |
| Incremental cost-effectiveness ratio (with productivity) | Cost saving | $19 | |||
| Incremental cost-effectiveness ratio (without productivity) | $52 | $79 | |||
Mil: million; Incremental cost-effectiveness ratio: Cost per DALY averted; IPD: Invasive pneumococcal disease.
In this analysis, following World Health Organization recommendations [14], future costs and health outcomes were both discounted to their present values (in the year 2014) at a rate of 3% per annum. Discounting allows for comparison of costs and benefits across different time periods, by weighting future gains and losses less heavily than those in the present to account for time value.
Both health system (excluding productivity losses) and societal (considering productivity losses and out-of-pocket expenses) perspectives are shown.
Figures are reported to two or three significant figures for visual clarity. Some apparent discrepancies may result due to this rounding.
Base case model assuming serotype replacement and herd protection (both direct and indirect effects of vaccine).
An alternate conservative model considering direct effects of vaccine alone (no serotype replacement and no herd protection).