BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) is part of the routine infant immunization schedules in Canada. Recently, Quebec has changed the recommendation to the 10-valent pneumococcal conjugate vaccine (PCV10). The purpose of this study is to evaluate the health and economic implications of potential disease re-emergence following a switch to a lower-valent vaccine in Quebec.
RESEARCH METHODS: A decision-analytic model using historical pneumococcal disease surveillance data to estimate disease trends and to forecast serotype re-emergence and/or reduction was applied. Serotype-specific incidence was modeled to compare maintaining PCV13 use versus switching to PCV10. For each vaccination program, health outcomes (cases of invasive pneumococcal disease, pneumonia, and otitis media (OM)), associated health-care costs, and changes in antimicrobial prescriptions and resistance were estimated. Costs (2018 Canadian dollars), utility weights, and risk of disease-specific sequelae were derived from available published sources. Incremental cost-effectiveness ratios were calculated across a number of scenarios.
RESULTS AND ANALYSIS: Assuming a 1 year lag before serotype replacement, maintaining PCV13 would avert an additional 180,000 cases of pneumococcal disease and 130 associated deaths compared to switching to PCV10 over 5 years. This would correspond to a net reduction of approximately 167,000 antibiotic prescriptions, or 1 prescription for every 2.5 infants vaccinated with PCV13. While vaccine costs were higher, PCV13 would be cost-saving due to fewer cases of disease in the PCV13 population. PCV13 remained cost-saving and under a number of sensitivity analyses.
