Cost-effectiveness and Budget Impact Analyses of Pneumococcal Vaccination in Indonesia

Presenter: Auliya Abdurrohim Suwantika

Co-authors: Vensya Sitohang, Gertrudis Tandy, Putri Herliana, Sri Rezeki Hadinegoro

Poster file: [download]
As a country with the high number of deaths due to pneumococcal disease, Indonesia has not yet included pneumococcal vaccination into the routine program. The aim of this study was to investigate the cost-effectiveness and budget impact analyses of pneumococcal vaccination in Indonesia. An age-structured cohort based on a decision tree model was developed to assess the cost-effectiveness and affordability values of universal pneumococcal vaccination in Indonesia by making comparison between two vaccines (PCV-10 and PCV-13) within two pricing scenarios (UNICEF and government contract price) in a 6-year time horizon analyses (2019-2014). A nationwide vaccination was targeted to be implemented in 2021. A single birth cohort of infants in each year was followed-up until 5 years of age with 1 month analytical cycles for children < 1 year of age and annual cycles beyond 1 year. The result showed that vaccination would reduce pneumococcal disease by 1,696,548 and 2,268,411 cases when using PCV-10 and PCV-13, respectively. Vaccination would save treatment cost from the payer perspective at $54 million and $71 million for PCV-10 and PCV-13, respectively. The Incremental Cost-Effectiveness Ratio (ICER) would be $218 and $162 per QALY-gained for PCV-10 and PCV-13, respectively, under the UNICEF price. Applying the contract price, the ICER would be $997 and $747 per QALY-gained for PCV-10 and PCV-13, respectively. Vaccine cost per 1 vaccinated child was estimated to be $5.27/dose and $17.5/dose under UNICEF and contract price, respectively. Implementation of nationwide PCV vaccination would require approximately $61-63 million (17-20% of routine immunization budget) and $238-244 million (67-80%) under UNICEF and contract price, respectively. Sensitivity analysis showed that vaccine efficacy, mortality rate and vaccine price were the most influential parameters affecting the ICER. In conclusion, pneumococcal vaccination would be a highly cost-effective intervention to be implemented in Indonesia. Yet, applying PCV-13 under UNICEF price would give the best cost-effectiveness value and biggest budget impact on routine immunization budget.