POSB273 Recommendations and Health Technology Assessment (HTA) Landscape Evaluation Study for Pediatric Pneumococcal Conjugate Vaccine (PCV) in Europe: A Systematic Literature Review

As of March 2019, 144 countries (74%) have introduced PCV into their childhood national immunization programmes (NIP), 15 (8%) have announced plans to do so, and 35 (18%) have yet to make a decision. Objective of this study was to gain a better understanding of how European HTA agencies and National Immunization Technical Advisory Groups (NITAGs) use disease related data and evidence to form their recommendations regarding inclusion of PCV in the NIP. A systematic literature review (SLR) was performed by searching HTA agency/NITAG websites, EMBASE, Medline and Google for published PCV recommendations up until October 2020. The EU-27 countries, including Iceland, Norway, Switzerland and the UK were included in the SLR. A total of 46 documents were identified with 35 (76%) of the identified documents containing a recommendation that was either positive or negative in regard to PCV. The remaining 11 (24%) documents were either cost-effectiveness analyses (n=10) or a summary of the evidence (n=1) that did not give any recommendation. All identified documents with recommendations based their recommendation on epidemiological invasive pneumococcal disease (IPD) data, then to varying degree on epidemiological data on acute otitis media (AOM) and pneumonia. Out of these, 5 (14.3%) were negative regarding either PCV7 or PCV10. The rationale for the negative recommendations were insufficient evidence (PCV7) or that the clinical benefit was not compelling enough (PCV10) to complement PCV13. Two factors were identified to have the greatest overall impact on the estimated cost-effectiveness of PCVs in the NIP; assumptions regarding herd protection and the choice of dosing regimen (3+1 or 2+1 schedule). Relevant records were identified for 19 of the 31 included countries, where all records with PCV recommendation also reported IPD epidemiological burden evidence/data. Epidemiological burden evidence on AOM and pneumonia varied with country and year of recommendation.