Potential impact of introducing the pneumococcal conjugate vaccine into national immunization programmes: an economic-epidemiological analysis using data from India

Pneumococcal pneumonia causes an estimated 105,000 child deaths in India annually. The planned introduction of the serotype-based pneumococcal conjugate vaccine (PCV) is expected to avert child deaths, but the high cost of PCV relative to current vaccines provided under the Universal Immunization Programme has been a concern. Cost-effectiveness studies from high-income countries are not readily comparable because of differences in the distribution of prevalent serotypes, population, and health systems. We used IndiaSim, an agent-based simulation model representative of the Indian population and health system, to model the dynamics of Streptococcus pneumoniae. We estimate that PCV13 introduction would cost approximately $240 million and avert $48.7 million in out-of-pocket expenditures and 34,800 (95% confidence interval [CI] 29,600–40,800) deaths annually assuming coverage levels and distribution similar to DPT (diphtheria, pertussis, and tetanus) vaccination (~77%). Introducing the vaccine protects the population, especially the poorest wealth quintile, from potentially catastrophic expenditure. The net-present value of predicted money-metric value of insurance for 20 years of vaccination is $160,000 (95% CI $151,000–$168,000) per 100,000 under-fives, and almost half of this protection is for the bottom wealth quintile ($78,000; 95% CI 70,800—84,400). Extending vaccination to 90% coverage averts additional lives and provides additional financial risk protection. Our estimates are sensitive to immunity parameters in our model; however, our assumptions are conservative, and if willingness to pay per years of life lost (YLL) averted is $228 or greater then introducing the vaccine is more cost-effective than our baseline (no vaccination) in more than 95% of simulations.