Evaluation of rotavirus, pneumococcal conjugate and human papillomavirus vaccination in four Pacific island countries: A cost-effectiveness modelling study

This peer-reviewed modelling study, published in PLOS Medicine (February 2026), evaluates the cost-effectiveness and budget impact of introducing rotavirus vaccine (RVV), pneumococcal conjugate vaccine (PCV), and human papillomavirus vaccine (HPVV) simultaneously in Samoa, Tonga, Tuvalu, and Vanuatu. Using the UNIVAC proportionate outcomes model and a 10-year vaccination programme horizon with lifetime health outcomes (discounted at 3%), the authors estimated disability-adjusted life years (DALYs), costs, incremental cost-effectiveness ratios (ICERs), and budget impact from a healthcare payer perspective, with additional societal analyses.

Key findings

• Simultaneous introduction of RVV, PCV, and HPVV across the four countries could prevent an estimated 1,015 premature deaths over the lifetime of vaccinated cohorts (886 cervical cancer, 101 pneumococcal, 28 rotavirus deaths).
• The combined programme could avert over 33,000 outpatient visits and approximately 3,600 hospitalisations.
• At PAHO Revolving Fund prices, the joint ICER ranged from 0.43× to 0.73× GDP per capita, depending on the country.
• At lower vaccine prices, the ICER for introducing all three vaccines ranged from 0.15× to 0.58× GDP per capita.
• The programme would substantially increase immunisation budgets: annual vaccine spending would rise by 359% to 1,368% at full government financing (year six).
• Results were most sensitive to discount rates, disease burden assumptions, vaccine efficacy, and programme costs.

Thumbnail image credit: Gavi