Cost-effectiveness analysis of a maternal pneumococcal vaccine in low-income, high-burden settings such as Sierra Leone

Abstract Maternal pneumococcal vaccines have been proposed as a method of protecting infants in the first few months of life. In this paper, we assess the cost-effectiveness of a maternal pneumococcal polysaccharide vaccine using a health sector perspective. We estimate the costs of delivering a maternal pneumococcal polysaccharide vaccine, and the healthcare costs averted through the prevention of severe pneumococcal outcomes such as pneumonia and meningitis, with estimates of vaccine effectiveness based on previous research. Our model estimates that a maternal pneumococcal program would cost $570 per DALY averted (2020 USD, range $558-582), and hence not be cost-effective in our study setting of Sierra Leone using the nation’s GDP per capita of $527 as a benchmark. However, the choice of discounting rates for health outcomes determines whether the maternal pneumococcal vaccine was deemed cost-effective. Without discounting, the cost per DALY averted would be $277 (53% of Sierra Leone’s GDP per capita). Further, the cost per DALY averted would be $128 (24% GDP per capita) if PPV could be procured at the same cost relative to PCV in Sierra Leone as on the PAHO reference price list. Overall, our paper demonstrates that maternal pneumococcal vaccines have the potential to be cost-effective in low-income settings; however, their cost-effectiveness depends on the choice of discounting rates determined by social values, and negotiations with vaccine providers on vaccine price. Vaccine price is the largest cost driving the cost-effectiveness of a future maternal pneumococcal vaccine.