Pharmacoeconomic aspects of vaccination against Pneumococcal Infection in Russia

Pneumococcal infection prevention in children of the first 5 years of life in Russia is of high importance due to high morbidity and mortality. The goal of the study is pharmacoeconomic assessment of first year of life infants vaccination program by 13-valent conjugate pneumococcal vaccine (PCV13) for both routine vaccination by 3 doses and for selected vaccination of premature (born before 32 week of pregnancy) children by 4 doses. Modeling based on clinical trials and epidemiology data results has been established. The costs of Medical care have been obtained from the 2011 State Insurance tariff in St.Petersburg. Analysis has been done from the position of the Health Care system (only direct medical costs) and from the social perspective (analysis of direct medical and indirect costs) with 10 and 20 years horizon and for the full length of life. In routine vaccination scenario and in case of investing to the Health Care system for 10 years cost effectiveness of PCV13 in general population of children including herd effect is 44,2K rubles/1 additional life year gained for direct medical costs only. In direct and indirect costs estimating vaccination is dominating – so, not only decreasing the incidence and morbidity but cost-saving for 2,1K rubles per patient. Study horizon extension (prolongation of the period when the State is ready to wait for the return of investment) is leading to the vaccination cost-effectiveness increase: without herd effect the cost/effectiveness is 505,1K rubles per 1 additional life year gained in 10 years horizon and 100,6K rubles in analysis for the full length of life. Selected vaccination of premature children is also cost effective as these children are at real high risk for Pneumococcal Infection – efficiency in 10 years horizon for direct medical costs is 131,2K rubles per 1 additional life year gained and for indirect and direct costs is 48,3K rubles per 1 additional life year gained. But it is important to mention that routine vaccination of all children during the first year of life is more efficient due to herd effect starting from the third year of the routine immunization start. According to the WHO recommendations efficiency of medical interventions can be assessed by comparison with the NDP – in Russia in 2012 this has been 316K rubles per citizen. Therefore, PCV13 can be recommended for inclusion and addition to the Russian National Immunization Calendar due  to the high clinical effectiveness with appropriate cost-effectiveness even its’ implementation needs significant increase of budget investment to vaccination. Routine vaccination is economically more preferable and efficient in comparison to selected groups’ vaccination and will provide the return of investment and budget cost savings in 10 years period from the start.

1. Life tables for WHO Member States. Russian Federation. 2009. (www.who.int)

2. Брико, Н. Распространенность и возможности профилактики пневмококковых инфекций в мире и России /Н. Брико // Вакцинация. – 2009. – Сентябрь. – www.privivka.ru

3. Российский статистический ежегодник. 2009: Стат. сб./Росстат. – М. – 2009. – 795 с.

4. Rozenbaum, M. Cost effectiveness of pneumococcal vaccination among Dutch infants: an economic analysis of the seven valent pneumococcal conjugated vaccine and forecast for the 10 valent and 13 valent vaccines / M. Rozenbaum [et al.] //BMJ. – 2010. – V. 340. – P. 2509–2518.

5. Федосеенко, М.В. Перспектива вакцинопрофилактики пневмококковой инфекции: современный взгляд на проблему / М.В. Федосеенко // РМЖ. – 2009. – Т. 1. – С. 36–41.

6. Vestrheim, D.F. Effectiveness of a 2+1 dose schedule pneumococcal conjugate vaccination programme on invasive pneumococcal disease among children in Norway / D.F. Vestrheim [et al.] // Vaccine. – 2008. – V. 26. – P. 3277–3281.

7. Health Protection Agency. Cumulative weekly number of reports of invasive pneumococcal disease in England and Wales by epidemiological year July–June. 2009 // www.hpa.org.uk

8. Приложения к Генеральному тарифному соглашению по тарифам на медицинскую помощь (медицин ские услуги) и условиям оплаты медицинской помощи, оказываемой в рамках действующей Территори альной программы обязательного медицинского страхования граждан Российской Федерации в Санкт-Петербурге на 2011 г. (www.spboms.ru)

9. Hubben, G. Enhanced decision support for policy makers using a web interface to health-economic models--illustrated with a cost-effectiveness analysis of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine in the Netherlands / G. Hubben [et al.] // Vaccine. – 2007. – V. 25 (18). – P. 3669–3678.

10. Tilson, L. Economic evaluation of a universal childhood pneumococcal conjugate vaccination strategy in Ireland / L. Tilson [et al.] // Value Health. – 2008. – V. 11 (5). – P. 898–903.

11. Snedecor, S. Transmission-dynamic model to capture the indirect effects of infant vaccination with Prevnar (7-valent pneumococcal conjugate vaccine (PCV7)) in older populations / S. Snedecor [et al.] // Vaccine. – 2009. – V. 27(34). – P. 4694–703.

12. Simonsen, L. Impact of Pneumococcal Conjugate Vaccination of Infants on Pneumonia and Influenza Hospitalization and Mortality in All Age Groups in the United States / L. Simonsen [et al.] // mBio. – 2011. – V. 2: e00309-10.

13. Занятость и безработица в мае 2011 г. // www.gks.ru

14. Rodenburg, G.D. Effects of pneumococcal conjugate vaccine 2 years after its introduction, the Netherlands / G.D. Rodenburg [et al.] // Emerg. Infect. Dis. – 2010. – V. 16. – P. 816–823.

15. Lepoutre, A. Impact of infant pneumococcal vaccination on invasive pneumococcal diseases in France, 2001–2006 /A. Lepoure [et al.] // Euro Surveill. – 2008. – V. 13. – P. 18962.

16. World Health Organization. Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health. Geneva (Switzerland): World Health Organization; 2001.

17. Pelton, S. The future of pneumococcal conjugate vaccines for prevention of pneumococcal diseases in infants and children / S. Pelton, J. Klein // Pediatrics. – 2002. – V. 110 (4). – P. 805–814.