Barbara Jauregui

Strengthening the technical capacity at country-level to make informed policy decisions on new vaccine introduction: Lessons learned by PAHO's ProVac Initiative

Rotavirus, pneumococcal conjugate and HPV vaccines have the potential to make substantial gains in health, specifically in reducing child mortality and improving womens health. Decisions regarding new vaccine introduction should be grounded in a broad evidence base that reflects national conditions. In this paper, we describe the Pan American Health Organization ProVac Initiatives experience in strengthening national decision making regarding new vaccine introduction through five sets of activities: (1) strengthening infrastructure for decision making; (2) developing tools for economic analyses and providing training to national multidisciplinary teams; (3) collecting data, conducting analysis, and gathering a framework of evidence; (4) advocating for evidence-based decisions; and (5) effectively planning for new vaccine introduction when evidence supports it. Key lessons learned regarding the role of multidisciplinary country teams, provision of direct technical support, development of tools, and provision of distance and in-person training are highlighted.

Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina

OBJECTIVE Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. METHODOLOGY The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organizations ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3+1 (three doses+booster) schedule and a vaccination price of US

TRIVAC decision-support model for evaluating the cost-effectiveness of Haemophilus influenzae type b, pneumococcal and rotavirus vaccination.

20.75 per dose was assumed in the base case for both vaccines. RESULTS Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

8973 and US

Challenges to building capacity for evidence-based new vaccine policy in developing countries.

10,948 for PCV-10 and PCV-13 respectively, and US

Monitoring of progress in the establishment and strengthening of national immunization technical advisory groups

8546 and US

Human papillomavirus vaccines: new tools for accelerating cervical cancer prevention in developing countries

10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US

Descriptive analysis of immunization policy decision making in the Americas

28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. CONCLUSION Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system.

ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions.

The TRIVAC decision support model has been used widely in Latin America and other regions to help national teams evaluate the cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine, pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV). We describe the structure and functioning of this model, and identify the parameters with the greatest influence on the results. The TRIVAC model is a spreadsheet software program that calculates incremental cost-effectiveness ratios (ICERs) and other indicators for three childhood vaccines (Hib, PCV and RV) utilising parameters such as demography, disease burden, vaccine costs, vaccine coverage, vaccine efficacy, health service utilisation and costs. There is a good deal of uncertainty about the local values of many of the parameters that have most influence on the cost-effectiveness of these new vaccines. Cost-effectiveness models can be used to explore the implications of different values of these parameters. However, for such models to be seen as relevant and helpful by decision-makers, they need to be transparent, flexible, easy to use, and embedded in a process which is owned and led by national teams. In this paper the key drivers of cost-effectiveness in the model are identified by one-way sensitivity analyses, run for each vaccine in 147 countries. The data used are mainly from standard international sources and the published literature. The primary indicator was the discounted cost per Disability Adjusted Life-Year (DALY) averted, from a government perspective, over a 20-year period (2013-2032). For all three vaccines, the ICER was most sensitive to changes in relative coverage (the coverage of the children who would have become diseased or, more importantly, died if the population had not been vaccinated, as a % of overall national coverage) and the herd effect multiplier. Other influential parameters for all three vaccines were: the incidence and case fatality of disease, the baseline trend in disease mortality in the absence of vaccination, vaccine efficacy, vaccine price and the % decline in vaccine price per year. Important vaccine-specific parameters included the cost of Hib meningitis sequelae, PCV serotype coverage and the rotavirus gastro-enteritis (RVGE) admission rate. While vaccine efficacy, herd effects, disease mortality and vaccine price are commonly cited as important drivers of cost-effectiveness, this analysis highlights the potentially important influence of relative coverage, a parameter rarely considered in models of vaccine impact and cost-effectiveness.

Indicators to assess National Immunization Technical Advisory Groups (NITAGs)

OBJECTIVE To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age. METHODS The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organizations ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed. FINDINGS For the 20 cohorts, net costs with PCV10 and PCV13 were US