POSC119 Cost-Effectiveness of Switching from the 10-Valent to the 13-Valent Pneumococcal Conjugate Vaccine in Sweden

Pneumococcal disease remains one of the most common vaccine preventable diseases worldwide, causing invasive pneumococcal disease (IPD) such as meningitis and non-invasive disease such as pneumonia and acute otitis media (AOM). The introduction of pneumococcal conjugate vaccines (PCVs) in pediatric vaccination programs have had a substantial impact from widespread use, however disease burden remains due to non-vaccine serotypes and replacement serotypes. In Sweden, where the 10-valent vaccine (PCV10) is part of the infant national immunization program (NIP), only 7% of residual disease is due to PCV10 serotypes, however 29% is due to serotypes 3, 6A, and 19A, which are covered in the 13-valent vaccine (PCV13). The objective of this study is to determine the cost-effectiveness of switching from PCV10 to PCV13 in Sweden’s NIP. A forecasting model was developed to estimate the health and economic impact of switching infant vaccination from PCV10 to PCV13. The model is based on real world surveillance data in Sweden and countries with PCV10 and PCV13 NIPs to project future IPD incidence across all ages to capture direct and indirect protection. Future rates of non-invasive disease are assumed to change proportionally relative to IPD. Costs and utilities are accounted for each outcome and compared across vaccination strategies over a 5-year time horizon. Switching to PCV13 is estimated to prevent 545 IPD cases, 6,349 pneumonia cases, 10,055 AOM cases, and 320 deaths over 5 years compared to maintaining PCV10. Despite the greater investment, PCV13 is cost-saving compared to PCV10, and would reduce healthcare spending by over 9.8 million SEK over 5 years. Replacing PCV10 with PCV13 will provide incremental coverage and greater value in Sweden prior to the availability of higher valent vaccines, including 15- and 20-valent PCVs which will provide residual coverage of 35% and 53%, respectively, in children under 5.