# Comparison of 13-, 15- and 20-valent pneumococcal conjugate vaccines in the paediatric Canadian population: A cost-utility analysis

## TL;DR

This study compares the cost-effectiveness of three pneumococcal vaccines in Canadian children, finding that newer vaccines may offer better value if they reduce disease spread significantly.

## Contribution

The study evaluates the cost-utility of new pneumococcal vaccines in Canada, considering both direct and indirect effects on disease burden.

## Key findings

- Pneu-C-20 and Pneu-C-15 are projected to reduce pneumococcal disease burden compared to Pneu-C-13.
- Cost-effectiveness of Pneu-C-15 and Pneu-C-20 depends on the magnitude of indirect vaccine effects.
- ICERs for Pneu-C-20 and Pneu-C-15 fall below $30,000 per QALY gained with sufficient indirect effects.

## Abstract

Two pneumococcal conjugate vaccines, covering 15 and 20 Streptococcus pneumoniae serotypes (Pneu-C-15 and Pneu-C-20, respectively), were recently approved for use in the Canadian paediatric population.

To assess the cost-effectiveness of Pneu-C-15 and Pneu-C-20 in unvaccinated infants initiating routine pneumococcal vaccination, compared to the currently used 13-valent conjugate vaccine (Pneu-C-13).

A static cohort model was used to estimate sequential incremental cost-effectiveness ratios (ICERs in 2022 Canadian dollars per quality-adjusted life year [QALY]) of Pneu-C-13, Pneu-C-15 and Pneu-C-20 in the paediatric population starting their primary series. Costs and outcomes were calculated over a 10-year time horizon at the program level and a lifetime time horizon at the individual level and discounted at a rate of 1.5% per year. We explored the impact of uncertainties in model parameters and assumptions in scenario and sensitivity analyses.

Routine use of Pneu-C-20 and, to a lesser extent, Pneu-C-15 is projected to reduce pneumococcal disease burden, compared to Pneu-C-13. Based on product cost assumptions, sequential ICERs for Pneu-C-15 and Pneu-C-20 were $58,800 and $135,200 per QALY gained from the health system perspective and $18,272 and $93,416 per QALY gained from the societal perspective, excluding indirect effects. A reduction in serotype-attributable disease due to indirect vaccine effects of 5% or greater resulted in ICERs below $30,000 per QALY gained for Pneu-C-15 and Pneu-C-20, with the optimal strategy determined by the magnitude and time to reach a reduction in pneumococcal disease.

Both Pneu-C-15 and Pneu-C-20 are expected to increase QALYs in Canadian children compared to Pneu-C-13 and may be cost-effective interventions.