Abstract
Pneumococcal disease is an infection carried on by the Streptococcus pneumoniae
(S.pneumoniae) bacterium, which results in malformation and death. In 2019, 1,228 children
per 100,000 children (<5 years old) were infected by S.pneumoniae and 11% of them died,
especially in cases of invasive pneumococcal illness in children younger than 5 years old.
Pneumococcal conjugate vaccine (PCV) can help with prevention and has been established
and introduced into the National Immunization Program (NIP) worldwide. The 10-valent PCV
and the 13-valent PCV are two vaccine types that have been registered in Thailand, but is
currently not included in Thailand's national immunization program. There has been
conflicting results on the value-for-money of PCV for children. The National Vaccine
Subcommittee has considered the introduction of PCV vaccine in the NIP in Thailand with
updated information (e.g. a lowered vaccine price and more recent epidemiological data).
Therefore, an economic evaluation and budget implication were requested by policymakers
to examine the cost-effectiveness of 10-valent PCV (PCV10) or 13-valent PCV (PCV13)
compared to no vaccine among children under 6 months old in Thailand.
Results
In the base-case scenario of without herd immunity effects, the ICER for 2+1 and 3+1
schedule of PCV10 were THB 208,436 and THB 293,167 per QALY gained, respectively. The
ICER for 2+1 and 3+1 schedule of PCV13 were THB 349,684 and THB 466,898 per QALY gained,
respectively. With herd immunity effect, 2+1 and 3+1 schedule of PCV10 resulted in a
reduction in costs THB 217,492 and THB 178,699 per QALY gained, respectively (i.e. PCV10 was
a dominant option). Additionally, 2+1 and 3+1 schedules of PCV13 when compared to no
vaccine showed a reduction in costs THB 342,353 and 309,805 per QALY gained, respectively
(i.e. PCV13 was a dominant option). According to a willingness to pay THB 160,000 per QALY
gain, PCV10 and PCV13 were cost-effective compared to no vaccine any child under 6 months
old for the societal perspective in Thailand.
The budget impact analysis of immunisation focused on all children under the age of
six months during a five- year period. The scenario of without herd immunity effect, PCV
vaccination can reduce the cost of infectious disease treatment compared to the cost of
treatment without PCV vaccine but the government will also have to invest more on vaccine
cost and vaccine freight (logistics) cost. The 2+1 and 3+1 schedule PCV10 vaccination will
require an additional investment of 3 billion baht and 4.2 billion baht, respectively, and the
2+1 and 3+1 schedule PCV13 vaccination will require an additional investment of 3. 8 billion
baht and 5.2 billion baht, respectively. However, with herd immunity effect scenario, PCV
vaccination can reduce the cost of infectious disease treatment compared to the cost of
treatment without PCV vaccine, and the reduction in the cost difference with PCV vaccine is
greater than the total cost of vaccination and vaccine freight cost. PCV10 vaccine in the 2+1
and 3+1 schedule will reduce the budget burden by 1.3 billion baht and 47 million baht,
respectively, and the PCV13 vaccine in the 2+1 and 3+1 schedule will reduce the burden. The
budget was 5.9 billion baht and 4.4 billion, respectively.
Policy recommendations
1. In Thai context, PCV vaccine is economically attractive; and therefore, should be
included contain in Thailand National Immunization Program for all newborns and
children younger than 6 months old.
2. To encourage price competition and the state’s benefit, only one vaccine should be
introduced by considering the result of cost effectiveness including herd immunity.
However, the potential shortage of vaccine due to the purchase of single vaccine
should be also considered.
3. According to the herd immunity of PCV vaccination associate to the cost effectiveness
of vaccine, collaborations between the public and commercial sectors should be
established to ensure that all children living in Thailand receive appropriate and
continuous vaccination.
4. Given the budget of vaccine and associated logistic cost of THB 3.8 – 4.5 billion in case
of 2+1 schedule and 5.1 – 6.0 billion in case of 3+1 schedule over a 5-year period,
which is a relatively high budget, PCV vaccine prices should be negotiated with
manufacturers.
