Cost effectiveness sensitivity
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Contents
Question
The effects of alternative vaccine compositions on the outcomes of the cost-effectiveness analysis were assessed. Results are reported for PCV10 with modified effects for serotypes 19A and 6A and for PCV13 with modified effects for serotypes 3 and 6C.
Answer
Conclusion: The assumption about serotype 3 in PCV13 is crucial. In addition, assumptions about the role of 6A in PCV10 is important.
If serotype 3 is not included as a vaccine type in PCV13, then the differences between PCV10 and PCV13 in IPD, quality adjusted life years gained and medical costs are small (see Tables 1-7 in Section 1 below). Considering the magnitudes of these differences in view of the intrinsic uncertainties in the model, PCV10 and PCV13 can be regarded as equally effective.
Rationale
1.Vaccine effects on IPD, QALYs and costs by age group for alternative scenarios
Quantities tabulated:
IPD = number of IPD cases per year in Finland
IPD decrease = decrease in IPD due to the first mentioned vaccine
QALYs lost = QALYs lost due to IPD per year in Finland, in years
QALY=quality adjusted life year
QALYs gained = QALYs gained due to the first mentioned vaccine
Medical costs = Medical costs due to IPD per year in Finland in 1000 euros
Medical savings = Difference in medical costs in 1000 euros per year in favor of the first mentioned vaccine
Vaccine formulation considered: PCV10 includes the 10 serotypes in PCV10 and direct effects for serotypes 6A and 19A PCV10(6Af) includes the 10 serotypes in PCV10 amended by serotype 6A and direct effects (##) for 19A PCV13 includes 12 serotypes in PCV13, serotype 3 excluded. Assumes direct effects for serotypes 3 and 6C. PCV13(6Cf) includes 12 serotypes in PCV13, serotype 3 excluded and 6C added. Assumes direct effects for serotypes 3.
* 1.No Vaccination
-------------- age group
0- 4 5- 19 20- 44 44- 64 65- 100 Total
---- ----- ----- ----- ------ -----
IPD 330 26 124 236 302 1017
QALYs lost 156 12 284 605 558 1615
Medical costs (#) 918 70 1279 2431 2146 6843
* 2.PCV10 vs "No Vaccination"
-------------- age group
0- 4 5- 19 20- 44 44- 64 65- 100 Total
---- ----- ----- ----- ------ -----
IPD decrease 225 15 49 30 45 362
QALYs gained 105 7 102 76 86 376
Medical savings(#) 608 37 504 306 320 1774
* 3.PCV13 vs "No Vaccination"
-------------- age group
0- 4 5- 19 20- 44 44- 64 65- 100 Total
---- ----- ----- ----- ------ -----
IPD decrease 246 15 43 16 47 366
QALYs gained 114 7 86 39 89 334
Medical savings 656 38 443 160 335 1631
* 4.PCV13 vs PCV10
-------------- age group
0- 4 5- 19 20- 44 44- 64 65- 100 Total
---- ----- ----- ----- ------ -----
IPD decrease 21 0 -6 -14 2 4
QALYs gained 9 0 -16 -37 3 -42
Medical savings 48 1 -61 -146 15 -143
* 5.PCV13(6Cf) vs PCV10
-------------- age group
0- 4 5- 19 20- 44 45- 64 65-100 Total
---- ----- ------ ------- ------ -----
IPD decrease 11 -1 -11 -29 -10 -40
QALYs gained 4 -1 -29 -76 -21 -123
Medical savings 17 -2 -116 -299 -74 -474
* 6.PCV13 vs PCV10(6Af)
-------------- age group
0- 4 5- 19 20- 44 45- 64 65- 100 Total
---- ----- ------ ------- ------ -----
IPD decrease 31 2 1 6 14 54
QALYs gained 15 1 1 13 28 57
Medical savings 83 5 10 55 103 256
* 7.PCV13(6Cf) vs PCV10(6Af)
-------------- age group
0- 4 5- 19 20- 44 45- 64 65- 100 Total
---- ----- ------ ------- ------ -----
IPD decrease 21 1 -4 -9 2 10
QALYs gained 10 0 -12 -26 4 -24
Medical savings 52 2 -45 -98 14 -75
Interpretation ------- Table 1 displays quantities when no vaccination is applied and Tables 2-3 display results for the default scenarios PCV10 and PCV13. The vaccines decrease QALYs and medical costs by approximately 20-25%. In comparison to these effets, the differences pertaining to pairwise comparisons of various versions of the vaccines (Tables 4-7) are small. Negative numbers in Tables 4-7 indicate situations favorable to PCV10.
(*)= In the calculations above, the original observed/predicted number of IPD cases among under 3 year old children is multiplied 3.75. This adjustment was made to better reflect the actual disease incidence (reference: Palmu et al. (2014) Vaccine effectiveness of the pneumococcal..,The Lancet Resp. Med.Vol2,9,p.717-) (#)= costs and savings are given in 1000 euros (##)= a vaccine with "only direct effects" for a particular serotype means that, for vaccinated persons, vaccine efficacy against IPD caused by this serotype is 90% with a waning rate of 10% per year. In practise this means that approximately 70% of the serotype-specific IPD is eliminated among the <5 year olds. The implications of this modification to the results pertaining to the population as a whole are quite small and correspond closely to assuming no vaccine efficacy against the serotype in question.
2. Acceptable price level for PCV13 for a fixed price of PCV10 under alternative scenarios
Three separate tables are displayed, each corresponding to a different quantity.
The three quantities of interest are:
* PCV13adv.inIPD = PCV13 advantage in IPD
= (IPD under PCv10) - (IPD under PCV13)
if positive, PCV13 saves IPD cases compared to PCV10
* price of PCV13
= if PCV10 price set at 20e, what is the matching price for PCV13?
* ICER
= incremental cost-effectiveness ratio for PCV10 at price 20e
(in this table, this value is also average cost per QALY)
rows (vaccine composition PCV10 and its 5 modifications): [1] pcv10 [2] pcv10 + 19A(direct effects only) [3] pcv10 + 6A [4] pcv10 + 19A(direct only) + 6A columns (vaccine composition PCV13 with or without serotype 3): [1] pcv13 - 3 (excluding serotype 3) [2] pcv13
PCV13adv.inIPD price of PCV13 ICER
============== ============== ===============
PCV13-3 PCV13 PCV13-3 PCV13 PCV13-3 PCV13
--- --- ------- ----- ----- ----
pcv10 12 150 18 38 8077 8077
pcv10+19Ad -2 134 17 37 7714 7714
pcv10+6A 50 188 25 55 13590 13590
pcv10+19Ad+6A 32 169 24 52 12724 12724
----------------
(PCV10 price=20)
Interpretation ------- The inclusion of serotype 3 (with full indirect effects) in PCV13 is crucial. If serotype 3 is not included in PCV13 8the default scenario), then the acceptable cost for PCV13 can be either above or below the cost of PCV10, depending on assumptions regarding the role of 6A in PCV10.
See also
