BACKGROUND/OBJECTIVES: PCV13 is part of the routine infant immunization schedule in all Canadian provinces. Use of PCV13 has reduced pneumococcal disease incidence for the vaccine serotypes, particularly 19A, which rapidly emerged with PCV7 use. PCV10 contains the same serotypes as PCV13 with the exception of serotypes 3, 19A and 6A. This study evaluated the hypothetical health and economic implications of switching from PCV13 to PCV10 in Canada.
METHODS: A decision-analytic model was developed to estimate public health and economic impacts of switching infant vaccination to PCV10 across all Canadian provinces versus maintaining PCV13. Disease incidence at time of potential switch was obtained from surveillance data (invasive pneumococcal disease; IPD), discharge abstract database (pneumonia; PNE) and published literature (acute otitis media; AOM). Historical data was used to estimate IPD trends under different vaccine pressures and then the model forecasted disease for infants (direct vaccination effects) and older age groups (indirect effects of infant vaccination). For each vaccination program, health outcomes and associated health-care costs were estimated. Costs (2015 Canadian dollars), utility weights, and risk of disease-specific complications were derived from published sources.
RESULTS: In the base case, assuming a 2-year lag before disease re-emergence occurs, continued use of PCV13 would result in significantly fewer cases of pneumococcal disease than PCV10. Despite a higher vaccine cost, PCV13 was cost-saving compared to PCV10 in the base case and across a number of scenarios evaluated.
CONCLUSION: Continued use of PCV13 in Canada is predicted to provide greater public health benefit compared to switching to PCV10. It is important that policy makers consider potential implications of disease re-emergence of non-covered serotypes when considering modifications to vaccination strategies.
