Cost-effectiveness of introducing infant vaccination against pneumococcal disease in Poland – comparison of non-typeable Haemophilus influenzae protein D (PHiD-CV) and 13-valent (PCV-13) pneumococcal conjugate vaccines

Background: Streptococcus pneumoniae can cause invasive pneumococcal diseases (IPD), pneumonia and acute otitis media (AOM), a common childhood infection that may require antibiotics. There were 3,236 IPD cases detected in Poland between 2006-2016, with incidence peaks among infants and the elderly. The case-fatality rate in 2016 was 6.7% among infants and 49.3% among the elderly. Since 2009, two infant pneumococcal conjugate vaccines are available in Poland (the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine [PHiD-CV], and the 13-valent pneumococcal conjugate vaccine [PCV-13]). The objective of this study was to assess the cost-effectiveness of routine PHiD-CV versus no vaccination and versus PCV-13. Methods: A previously published Markov cohort model was adapted for Poland to compare PHiD-CV to no vaccination and PCV-13 from the public payer perspective, regarding lifetime direct costs and quality-adjusted life years (QALYs) associated with morbidity and mortality due to IPD, pneumonia and AOM. PHiD-CV and PCV-13 were assumed to have the same efficacy for their ten common vaccine serotypes, and PHiD-CV was assumed to have conservative cross-protection effectiveness against serotypes 6A and 19A, and to be more protective against AOM due to its effectiveness against non-typeable Haemophilus influenzae. Scenario analyses assessed outcomes when vaccine price parity was assumed, when the effectiveness of PHiD-CV against serotype 19A IPD was omitted or increased, and, when the effectiveness of PCV-13 against serotype 3 IPD was varied. Results: PHiD-CV was a cost-effective option versus no vaccination, with a cost per QALY gained of Polish złoty (PLN) 94,933 (below the threshold for cost-effectiveness of PLN 134,514). Both vaccines had comparable health outcomes regarding IPD and pneumonia, while PHiD-CV achieved better health outcomes against AOM. PHiD-CV was the dominant strategy for Poland versus PCV-13 (resulting in a gain of 170 QALYs at a direct cost-saving of PLN 61.1 million). In scenario and sensitivity analyses, PHiD-CV remained the dominant strategy versus PCV-13. Conclusions: The introduction of PHiD-CV in the Polish national immunization programme is likely to reduce the disease burden due to IPD, pneumonia and AOM. It is a cost-effective strategy (versus no vaccination) and a cost-saving strategy (versus PCV-13) for the healthcare payer.