The cost-effectiveness of using pneumococcal conjugate vaccine (PCV13) versus pneumococcal polysaccharide vaccine (PPSV23), in South African adults.

Streptococcus pneumoniae (pneumococcus) remains an important cause of morbidity and mortality. Pneumococcal vaccination is part of the South African pediatric public immunization program but the potential cost-effectiveness of such an intervention for adults is unknown. This study aimed to compare the cost-effectiveness of two widely used pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) in South African adults, 18 years and older. Four analyses were carried out in a) both the private and public health care sectors; and b) for the HIV-infected population alone and for the total mixed population (all HIV-infected and -uninfected people). A previously published global pharmacoeconomic model was adapted and populated to represent the South African adult population. The model utilized a Markov-type process to depict the lifetime clinical and economic outcomes of patients who acquire pneumococcal disease in 2015, from a societal perspective. Costs were sourced in South African rand and converted to US dollar (USD). The incremental cost divided by the incremental effectiveness (expressed as quality-adjusted life years gained) represented the incremental cost-effectiveness ratio for PCV13 compared to PPSV23. Results indicated that the use of PCV13 compared to PPSV23 is highly cost-effective in the public sector cohorts with incremental cost-effectiveness ratios of $771 (R11,106)/quality-adjusted life year and $956 (R13,773)/quality-adjusted life year for the HIV-infected and mixed populations, respectively. The private sector cohort showed similar highly cost-effective results for the mixed population (incremental cost-effectiveness ratio $626 (R9,013)/quality-adjusted life year) and the HIV-infected cohort (dominant). In sensitivity analysis, the model was sensitive to vaccine price and effectiveness. Probabilistic sensitivity analyses found predominantly cost-effective ICERs. From a societal perspective, these findings provide some guidance to policy makers for consideration and implementation of an immunization strategy for both the public and private sector and amongst different adult patient pools in South Africa.
Competing Interests: Charles Feldman: Charles Feldman acts on the advisory board and speaker’s bureau for Pfizer and received an honorarium for attendance of the Delphi panel meeting. Sipho Dlamini: Sipho Dlamini has received payment for lectures from the following companies Pfizer-South Africa, MSD-South Africa and Janssen Pharmaceutica. He has participated on an advisory board for MSD-South Africa and Pfizer-South Africa. He received an honorarium for attendance of the Delphi panel meeting. Shabir Madhi: Shabir Madhi has received institutional grants from BMGF, Pfizer, GSK and Novartis. He received an honorarium for attendance of the Delphi panel meeting. Susan Meiring: Susan Meiring has received travel funding only (flights and accommodation) to present at three meetings presented by Pfizer: AfMe Value Summit in 2016 and 2017 and the African Regional Pneumococcal Disease Scientific Meeting in 2016. She received an honorarium for attendance of the Delphi panel meeting. Anne von Gottberg: Anne von Gottberg received research funds to institution from Pfizer and Sanofi, and expenses reimbursed for educational travel by Pfizer, Sanofi and Novartis. Margreet de Necker: The pharmacoeconomic study performed by TCD Outcomes Research was funded by Pfizer. Margreet de Necker has consulted to other pharmaceutical companies in the past. Janetta Catharina de Beer: The pharmacoeconomic study performed by TCD Outcomes Research was funded by Pfizer. Janetta Catharina de Beer has consulted to other pharmaceutical companies in the past. Tienie Stander: The pharmacoeconomic study performed by TCD Outcomes Research was funded by Pfizer. Tienie Stander has consulted to Pfizer and other pharmaceutical companies in the past. This does not alter our adherence to PLOS ONE policies on sharing data and materials.