Table 1.

Model input parameters.

Parameters	Distribution	Mean	SE	Ref.
Pneumococcal meningitis incidence per 100,000a				[4], [7], [8]
Aged <1	Beta	131.69	15.37
Aged 1–4	Beta	12.85	2.39
Aged 5–14	Beta	7.55	1.07
Aged 15–19	Beta	4.60	0.36
Aged 20–49	Beta	4.60	0.88
Aged 50–64	Beta	4.11	1.33
Aged ≥65	Beta	5.32	15.37
Pneumococcal bacteraemia incidence per 100,000				[10]
Aged <4	Beta	11.1	1.84
Aged 5–19	Beta	1.4	0.33
Aged 20–49	Beta	1.9	0.28
Aged 50–64	Beta	4.6	0.79
Aged ≥65	Beta	13.6	2.02
All-cause pneumonia incidence per 100,000				[4]
Aged <1	Beta	19117.07	340.31
Aged 1–4	Beta	7373.52	109.60
Aged 5–14	Beta	708.28	20.21
Aged 15–19	Beta	277.82	8.32
Aged 20–49	Beta	277.82	36.02
Aged 50–64	Beta	809.48	61.77
Aged ≥65	Beta	1339.13	340.31
All-cause AOM incidence per 100,000				[4]
Aged <1	Beta	5267.77	188.32
Aged 1–4	Beta	3000.88	70.83
Aged 5–14	Beta	2395.54	37.01
Aged 15–19	Beta	1507.20	19.31
Aged 20–49	Beta	1507.20	49.23
Aged 50–64	Beta	1517.35	57.39
Aged ≥65	Beta	1155.00	188.32
PCV13 efficacyb
Vaccine-type IPD (3 + 1)	Beta	89.00%	3.57%	[12]
Radiologically-confirmed pneumonia (3 + 1)	Beta	25.50%	8.72%	[13]
All-cause AOM (3 + 1)	Beta	6.00%	1.53%	[12]
PCV10 efficacy
Vaccine-type IPD	Beta	92.00%	10.71%	[14]
Hospital-diagnosed pneumonia	Beta	28.00%	9.95%	[15]
All-cause AOM (3 + 1)	Beta	19.00%	6.89%	[16]
Vaccine serotype coverage in Bhutan
PCV7	Beta	31.58%	10.39%	RCDC
PCV10	Beta	47.37%	11.16%	RCDC
PCV13	Beta	57.89%	11.04%	RCDC
PCV7 serotype coverage in US				[17]
%Coverage in aged 10–39	Fixed	71.30%
%Coverage in aged 40–64	Fixed	65.40%
%Coverage in aged ≥65	Fixed	69.70%
%IPD fall among unvaccinated population in US				[18]
%Fall in aged 20–39	Beta	40.00%	4.59%
% Fall in aged 40–64	Beta	14.00%	4.59%
% Fall in aged ≥65	Beta	29.00%	3.57%
Probability of developing sequelae
Epilepsy after pneumococcal meningitis	Beta	10.34%	5.56%	[9]
Hearing loss after pneumococcal meningitis	Beta	3.45%	3.33%	[9]
Neurodevelopmental impairmentc after pneumococcal meningitis	Beta	34.48%	8.68%	[9]
Hearing loss after AOM	Beta	5.10%	0.06%	[6]
Case fatality rates
All-cause pneumonia	Beta	0.60%	0.07%	[4]
Pneumococcal meningitis	Beta	7.74%	1.43%	[4]
Pneumococcal bacteraemia	Beta	9.52%	3.67%	[9]
Direct medical costs (USD)				VPDP
PCV10 cost per dose	Fixed	3.05
PCV13 cost per dose	Fixed	3.55
Programme delivery cost per dose	Fixed	3.74
Treatment cost per episode				Primary data collection
Pneumococcal meningitis aged <1	Beta	394	157
Pneumococcal meningitis aged 1–4	Beta	400	159
Pneumococcal meningitis aged 5–14	Beta	410	168
Pneumococcal meningitis aged ≥15	Beta	433	198
Pneumococcal bacteremia aged <1	Beta	242	143
Pneumococcal bacteremia aged 1–4	Beta	248	149
Pneumococcal bacteremia aged 5–14	Beta	260	142
Pneumococcal bacteremia aged ≥15	Beta	315	162
Hospitalized pneumonia aged <1	Beta	82	19
Hospitalized pneumonia aged 1–4	Beta	83	19
Hospitalized pneumonia aged 5–14	Beta	83	20
Hospitalized pneumonia aged ≥15	Beta	122	11
Non-hospitalized pneumonia aged <1	Beta	9	3
Non-hospitalized pneumonia aged 1–4	Beta	9	3
Non-hospitalized pneumonia aged 5–14	Beta	9	3
Non-hospitalized pneumonia aged ≥15	Beta	21	1
AOM aged <1	Beta	9	2
AOM aged 1–4	Beta	9	2
AOM aged 5–14	Beta	9	2
AOM aged ≥15	Beta	4	2
Treatment cost per year				Primary data collection
Epilepsy aged <1	Beta	123	46
Epilepsy aged 1–4	Beta	122	45
Epilepsy aged 5–14	Beta	145	53
Epilepsy aged ≥15	Beta	170	64
Hearing loss aged <1	Beta	129	112
Hearing loss aged 1–4	Beta	129	112
Hearing loss aged 5–14	Beta	129	112
Hearing loss aged ≥15	Beta	129	112
Neurodevelopment impairment aged <1	Beta	191	58
Neurodevelopment impairment aged 1–4	Beta	191	58
Neurodevelopment impairment aged 5–14	Beta	191	58
Neurodevelopment impairment aged ≥15	Beta	189	55
Adjusted utilities for annual cycle (using HUI3)				[19]
Pneumococcal meningitis (utility = 0.34, for 20 days)	Beta	0.9638	0.0046
Pneumococcal bacteraemia (utility = 0.55, for 12 days)	Beta	0.9852	0.0025
Pneumonia (utility = 0.59, for 8 days)	Beta	0.9910	0.0020
AOM (utility = 0.71, for 2 days)	Beta	0.9984	0.0001
Epilepsy	Beta	0.6400	0.0738
Hearing loss	Beta	0.5500	0.0554
Mild mental retardation	Beta	0.6900	0.0707
Severe mental retardation	Beta	0.1000	0.1085
Mental retardation + epilepsy	Gamma	0.0001	0.0943

AOM: acute otitis media. IPD: invasive pneumococcal disease. RCDC: Royal Centre for Disease Control (http://www.rcdc.gov.bt/WEB/). VPDP: Vaccine Preventable Disease Programme, Department of Public Health.

^aAll-cause meningitis incidence [4] x Proportion of meningitis caused by S. pneumoniae (26.1% in child [7], 11.6% in adults [8]).

^bPCV13 values were derived based on PCV7 data. See details in the Supplementary Table 1.

^cNeurodevelopmental impairment included mild mental retardation, severe mental retardation and mental retardation with epilepsy.