Assessment of Health Benefits and Cost-Effectiveness of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Kenyan Children[精品].doc

AssessmentofHealthBenefitsandCost-Effectivenessof 10-Valentand13-ValentPneumococcalConjugate VaccinationinKenyanChildren PhilipAyieko1*,UllaK.Griffiths2,MosesNdiritu1,JenniferMoisi3,6,IsaacK.Mugoya4,TatuKamau4, MikeEnglish1,5,J.AnthonyG.Scott3,6,7 1KenyaMedicalResearchInstitute/WellcomeTrustProgramme,Nairobi,Kenya,2DepartmentofGlobalHealthandDevelopment,LondonSchoolofHygieneandTropical Medicine,London,UnitedKingdom,3KenyaMedicalResearchInstitute/WellcomeTrustProgramme,Kilifi,Kenya,4DivisionofVaccineandimmunizations,Ministryof Public Health and Sanitation, Nairobi, Kenya, 5Nuffield Department of Paediatrics, University of Oxford, Oxford, United Kingdom, 6Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom, 7Department of Infectious Disease Epidemiology, London School of Hygiene Tropical Medicine, London, UnitedKingdom Abstract Background: TheGAVIAlliance supported10-valent pneumococcalconjugatevaccine (PCV10)introductioninKenya. We estimatedthecost-effectivenessofintroducingeitherPCV10orthe13-valentvaccine(PCV13)fromasocietalperspective andexploredtheincrementalimpactofincludingindirectvaccineeffects. Methods:ThecostsandeffectsofpneumococcalvaccinationamonginfantsborninKenyain2010wereassessedusinga decisionanalyticmodelcomparingPCV10orPCV13,inturn,withnovaccination.Directvaccineeffectswereestimatedasa reductionintheincidenceofpneumococcalmeningitis,sepsis,bacteraemicpneumoniaandnon-bacteraemicpneumonia. Pneumococcal disease incidence was extrapolated from a population-based hospital surveillance system in Kilifi and adjustments were made for variable access to care across Kenya. We used vaccine efficacy estimates from a trial in The Gambia and accounted for serotype distribution in Kilifi. We estimated indirect vaccine protection and serotype replacementbyextrapolatingfromtheUSA.MultivariablesensitivityanalysiswasconductedusingMonteCarlosimulation. WeassumedavaccinepriceofUS$3.50perdose. Findings: The annual cost of delivering