Cost-Effectiveness Comparison of Pneumococcal Conjugate Vaccines in Turkish Children

The 13-valent pneumococcal conjugate vaccine (PCV13) is used for universal infant vaccination in Turkey. To assess the cost effectiveness of replacing PCV13 with pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). A Markov cohort model with monthly cycles following 1 cohort of infants over a 10-year time horizon was used. Local input parameters were obtained from published sources and expert consultation whenever possible. The model was adapted to estimate the health benefits and economic impact of each vaccine on invasive pneumococcal disease, pneumonia, and acute otitis media (AOM). An annual discount rate of 3% was used for benefits and costs (2016 euros). Under base-case assumptions, vaccinating 1 birth cohort of 1 325 783 infants with PHiD-CV instead of PCV13 was predicted to have the same impact on meningitis and pneumonia, a similar impact on bacteremia (+30 cases), but greater reductions in AOM-related general practitioner visits (−34 955) and hospitalizations (−624). Assuming equal vaccine prices, PHiD-CV was predicted to be dominant over PCV13 (176 additional quality-adjusted life-years while saving €635 330 [discounted]). One-way sensitivity analysis indicated that varying the vaccine price differential had the largest effect on the incremental cost-effectiveness ratio, and then AOM parameters. Probabilistic sensitivity analysis predicted PHiD-CV to be dominant over PCV13 in 92.4% of simulations. Any difference in price between PHiD-CV and PCV13 is expected to be the key driver of vaccine choice for preventing childhood pneumococcal disease in Turkey. At price parity, PHiD-CV use is likely to be a dominant strategy over the use of PCV13. •The pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine and the 13-valent pneumococcal conjugate vaccine are already established cost-effective protections against pneumococcal diseases in various countries, but their comparative cost effectiveness depends on the epidemiology and treatment costs in a specific setting.•Considering most up-to-date data, we assessed the differences between the 2 pneumococcal vaccines, their cost effectiveness, and the factors with the strongest impact on their comparative values. We predict that there is no difference in meningitis- and pneumonia-related health outcomes between both vaccines, and with different efficacy assumptions there is also no change in mortality related to invasive pneumococcal diseases; the key driv