Re-evaluating the impact and cost-effectiveness of pneumococcal conjugate vaccine introduction in 112 low-income and middle-income countries in children younger than 5 years: a modelling study

• Published in: The Lancet global health 2024-09, Vol.12 (9), p.e1485-e1497
• Main Authors: Chen, Cynthia, Ang, Gregory, Akksilp, Katika, Koh, Jemima, Scott, J Anthony G, Clark, Andrew, Jit, Mark
• Format: Article
• Language: English
• Subjects: Child, Preschool; Cost-Benefit Analysis; Developing Countries; Humans; Infant; Pneumococcal Infections - economics; Pneumococcal Infections - epidemiology; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - economics; Vaccines, Conjugate - administration & dosage; Vaccines, Conjugate - economics
• ISSN: 2214-109X; 2214-109X
• DOI: 10.1016/S2214-109X(24)00232-8

Streptococcus pneumoniae has been estimated to cause 9·18 million cases of pneumococcal pneumonia, meningitis, and invasive non-pneumonia non-meningitis disease and 318 000 deaths among children younger than 5 years in 2015. We estimated the potential impact and cost-effectiveness of pneumococcal conjugate vaccine (PCV) introduction. We updated our existing pseudodynamic model to estimate the impact of 13-valent PCV (PCV13) in 112 low-income and middle-income countries by adapting our previously published pseudodynamic model with new country-specific evidence on vaccine coverage, burden, and post-introduction vaccine impact from WHO–UNICEF estimates of national immunisation coverage and a global burden study. Deaths, disability-adjusted life-years (DALYs), and cases averted were estimated for children younger than 5 years born between 2000 and 2030. We used specific PCV coverage in each country and a hypothetical scenario in which coverage increased to diphtheria–tetanus–pertussis (DTP) levels. We conducted probabilistic uncertainty analyses. Using specific vaccine coverage in countries, we estimated that PCV13 could prevent 697 000 (95% credibility interval 359 000–1 040 000) deaths, 46·0 (24·0–68·9) million DALYs, and 131 (89·0–172) million cases in 112 countries between 2000 and 2030. PCV was estimated to prevent 5·3% of pneumococcal deaths in children younger than 5 years during 2000–30. The incremental cost of vaccination would be I$851 (510–1530) per DALY averted. If PCV coverage were increased to DTP coverage in 2020, PCV13 could prevent an additional 146 000 (75 500–219 000) deaths. The inclusion of real-world evidence from lower-income settings revealed that delays in PCV roll-out globally and low PCV coverage have cost many lives. Countries with delays in vaccine introduction or low vaccine coverage have experienced many PCV-preventable deaths. These findings underscore the importance of rapidly scaling up PCV to achieve high coverage and maximise vaccine impact. Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.