Pneumococcal disease remains a major cause of morbidity and mortality among children under five years of age, particularly in settings with low vaccine coverage. In China, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included in the National Immunization Program (NIP), resulting in suboptimal uptake. This study evaluated the health and economic impact of including PCV13 in the immunization program in Guangxi Zhuang Autonomous Region.
Methods
A decision tree-Markov model was used to simulate a birth cohort of 420,000 children over a 5-year horizon from a societal perspective. The current self-paid vaccination strategy was compared with NIP inclusion. Outcomes included costs, cases, deaths, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and benefit-cost ratios (BCRs). Costs and outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses were conducted.
Results
NIP inclusion increased vaccination coverage from 5900 to 417,019 children and was projected to prevent 77,042 cases and 327 deaths over 5 years. Despite higher vaccination costs, reduced disease burden resulted in a net economic benefit of USD 3.92 million (BCR: 1.03). The program generated an additional 25,702.2 QALYs, with an ICER of USD 6042.75 per QALY gained, below the per capita GDP threshold. Probabilistic sensitivity analysis showed that most simulations were below the willingness-to-pay threshold, with the probability of cost-effectiveness approaching 100%.
Conclusions
Including PCV13 in Guangxi's immunization program is highly cost-effective and likely to yield positive economic returns. These findings are robust and support policy decisions on PCV13 inclusion.
Aim
. To assess cost-effectiveness for vaccinating people ≥60 years against pneumococcal infection.
Material and methods
. Markov modeling was conducted using epidemiological data for the Russian Federation for people aged ≥60 years. The cost-effectiveness of monovaccination with a 23-valent polysaccharide vaccine (PPV23), sequential immunization with a 13-valent conjugate vaccine (PCV13) followed by PPV23 one year later, and vaccination with a 20-valent conjugate vaccine (PCV20) were assessed. The analysis was conducted from the perspective of society as a whole and from the healthcare system. The study time horizon was 10 years. Vaccine costs were analyzed based on registered prices, including VAT. Costs and quality-adjusted life expectancy were discounted by 3% per year. A sensitivity analysis assessed the cost-effectiveness of changing the price of PCV20 by 15% and reducing the time horizon to 5 years.
Results
. PCV20 vaccination reduces the incidence of pneumococcal infection compared to monovaccination with PPV23 and sequential PCV13/PPV23 immunization. When vaccinating individuals ≥60 years, the incremental cost per additional quality-adjusted life year (QALY) from a societal perspective would be RUB3,684,400, RUB2,087,300, and RUB1,385,600 for PPV23, PCV13/PPV23, and PCV20 vaccination, respectively. When analyzed from a healthcare system perspective, the cost-effectiveness ratios are RUB3,908,100/QALY, RUB2,288,700/ QALY, and RUB1,585,300/QALY for vaccination with PPV23, PCV13/ PPV23, and PCV20, respectively. A sensitivity analysis demonstrated the reliability of the obtained data.
Conclusion
. Vaccination of Russian people aged ≥60 years with PCV20 provides the greatest reduction in pneumococcal infection incidence and is highly cost-effective compared to PPV23 vaccination and is cost-effective compared to sequential PCV13/PPV23 vaccination. All vaccination options are cost-effective compared to no vaccination.
A. V. Rudakova, S. Avdeev, L. Namazova-Baranova et al.· CARDIOVASCULAR THERAPY AND P...· 0 citations
INTRODUCTION
Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccination guidelines recommending a single-dose 20-valent pneumococcal conjugate vaccine (PCV20) for adults at increased risk due to underlying medical conditions and later extending it to all adults aged 65 years and over. The objective of this analysis is first to evaluate the cost-effectiveness and public health impact of PCV20 in replacing 13-valent pneumococcal conjugate vaccine → 23-valent pneumococcal unconjugated polysaccharide vaccine (PCV13 → PPV23) in the vaccination programme and secondly to assess the value of extending the recommendation to a broader population.
METHODS
A deterministic Markov model was adapted to compare clinical and economic outcomes of adult pneumococcal vaccination strategies in France over a lifetime horizon. The economic inputs in this analysis were estimated in 2024 euros from a healthcare system perspective. Population parameters, epidemiological data and cost were derived from French databases and institutional reports. Utility and vaccine effectiveness inputs were obtained from the literature.
RESULTS
Replacing PCV13 → PPV23 with PCV20 in at-risk adults reduced pneumococcal disease burden and was a dominant strategy, generating cost savings of €56,786 at the population level (€1.05 per patient) while improving health outcomes with an incremental gain of 0.00015 QALYs per patient. Expanding PCV20 to all individuals aged 65+ further reduced disease incidence and mortality over a lifetime horizon, averting 900 additional invasive pneumococcal diseases (IPD) cases (mainly bacteremia and meningitis), 11,600 pneumonia cases, and over 1,500 deaths. These additional health benefits were achieved at an incremental cost of €63,191 at population level (€0.81 per patient) corresponding to a gain of 0.00019 QALYs per patient. The incremental cost-effectiveness ratio was 4,308 €/QALY, indicating highly cost-effective strategy relative to commonly cited French vaccine HTA benchmarks.
CONCLUSION
PCV20 is a cost-saving alternative to the PCV13 → PPV23 sequence for at-risk adults in France. Expanding recommendations to include all adults aged 65 years and over provides substantial public health gains and represents a highly cost-effective strategy.
S. Fiévez, Mélanie Menara, E. Blanc et al.· BMC Public Health· 0 citations
BACKGROUND
In Sweden, older adults and adults in clinical risk groups are recommended vaccination against pneumococcal disease, respiratory syncytial virus, influenza, and COVID-19. However, vaccine uptake remains inadequate. This study estimates the socioeconomic benefits of these immunization programs under current coverage compared to aspirational scenarios, assessing the value foregone due to suboptimal uptake.
RESEARCH DESIGN AND METHODS
We conducted a benefit-cost analysis from a societal perspective applying life table-based disease models to estimate benefit-cost ratios (BCRs) and net benefits (NBs). Health impacts were monetized through the value-of-a-statistical-life and cost-of-illness approaches. Costs comprised vaccination program expenses. Scenario and sensitivity analyses explore coverage and program eligibility.
RESULTS
Vaccination programs in older adults generated BCRs of 3:1 and NBs of SEK 54.4 billion over a lifetime (VSLY). When risk groups were included to model current strategies in Sweden, NBs increased to SEK 59.7 billion. Reaching aspirational coverage targets increased NBs by 18%, meanwhile restricting eligibility reduced NBs by 64%.
CONCLUSION
Adult respiratory vaccinations in Sweden provide substantial value for the healthcare system, economy and society, with estimated benefits exceeding costs under modeled assumptions. These findings may inform policy discussions on strategies to sustain or expand vaccination budget, improve access and increase uptake, particularly among at-risk populations.
E. Tunnicliffe, Matthew Napier, C. Theakston et al.· Expert Review of Vaccines· 0 citations
AIMS
In December 2025, the Advisory Committee on Immunization Practices recommended individual-based decision-making-termed shared clinical decision-making (SCDM) on CDC schedules-for hepatitis B (HepB) birth-dose vaccination in infants of mothers documented as HBsAg-negative at delivery. We evaluated projected economic, health, and distributional consequences for the 2026 US birth cohort.
MATERIALS AND METHODS
A hybrid decision tree-Markov cohort model took the societal perspective over a lifetime horizon for 3.6 million 2026 US births, under three coverage-decline scenarios (10-, 20-, and 30-percentage-point). Costs (2026 US dollars) and outcomes were discounted 3% annually. Outcomes included costs, infections, deaths, quality-adjusted life years (QALYs), and equity impacts by insurance, race/ethnicity, hospital type, and geography. Probabilistic sensitivity analysis used 10,000 iterations; reporting followed CHEERS 2022.
RESULTS
Under the base-case 20-percentage-point decline, SCDM was projected to produce approximately 44 additional acute infections, 8 additional chronic HBV cases, 2 additional HBV-related deaths (incomplete-linkage scenario), and 56 discounted QALYs lost per cohort. Assuming incremental counseling time for all policy-sensitive births, SCDM generated approximately $301 million in net societal cost-driven principally by provider counseling opportunity cost, not disease treatment-and was dominated by universal vaccination. With counseling time assigned zero cost, SCDM remained less effective but less costly, implying approximately $0.7 million per QALY to retain universal vaccination. Modeled burdens concentrated among Medicaid/CHIP and safety-net populations.
LIMITATIONS
This early assessment used scenario-based coverage-decline, counseling-time, mortality, and completion assumptions as post-policy data were unavailable; results are projections, not observations.
CONCLUSIONS
Moving from universal birth-dose vaccination to SCDM was projected to reduce timely vaccination and increase preventable infections across all scenarios. The societal-cost conclusion hinged on whether SCDM imposed counseling-time burden at scale, whereas the unfavorable health-effect direction was robust. Postimplementation evidence on coverage, counseling, completion, and linkage to care is needed before treating SCDM as low-cost or low-risk.
Y. T. Yang· Journal of Medical Economics· 0 citations
BACKGROUND
Typhoid fever remains a health threat in endemic countries. In Indonesia, it causes an estimated 470,000 cases and 6000 deaths annually. We assessed the cost-effectiveness and budget impact of introducing the typhoid conjugate vaccine (TCV) into Indonesia's routine National Immunisation Program (NIP) at 9 months of age, with or without a catch-up campaign up to 15 years of age.
METHODS
A validated dynamic model of typhoid transmission was used to project health outcomes over a 30-year analytical horison for each scenario. Cost-of-illness data were drawn from the Surveillance of Typhoid Fever in Indonesia study and published literature. Incremental cost-effectiveness ratios (ICERs) were estimated from healthcare sector and societal perspectives. Uncertainty was explored using one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). Budget impact analysis supported annual fiscal planning.
RESULTS
Six-year budget impact costs were US$61 million (routine) and US$251 million (routine and catch-up), equivalent to 0.48%-2.95% and 2.97%-9.84% of the annual national immunisation budget, respectively. Compared to no vaccination, routine TCV yielded ICERs at US$240.6 and US$238.8 per DALY averted from the healthcare sector and societal perspectives, respectively, corresponding to 5% of GDP per capita. Compared with routine immunisation alone, adding a catch-up campaign yielded ICERs of US$521.3 and US$519.5 per DALY averted from the healthcare sector and societal perspective, respectively, corresponding to approximately 11% of GDP per capita. OWSA showed that both strategies remained very cost-effective at a willingness-to-pay threshold of 1xGDP. PSA estimated probabilities of cost-effectiveness of 99.7% (routine and catch-up vs. routine) and 99.2% (routine vs. no vaccination). The multi-strategy cost-effectiveness acceptability curve identified the combined routine and catch-up campaign as the optimal strategy.
CONCLUSION
Introducing TCV into Indonesia's NIP is projected to be very cost-effective. A routine-only program requires a lower budget, but adding a catch-up campaign is an optimal strategy with greater public health impact while remaining very cost-effective.
FUNDING
Gates Foundation grants to Murdoch Children's Research Institute in collaboration with Universitas Gadjah Mada [ref. no. INV-003867] and to TyVAC 2.0 [ref. no. INV-030857].
J. Haposan, J. A. Thobari, Emma Watts et al.· Vaccine· 0 citations
Background: Implementation delays reduce population-level effects of evidence-based interventions. We conducted a modeling study to estimate the effect of priority policy decisions on a human papillomavirus (HPV) vaccination program in Kenya. Methods: We used a static cohort model to estimate the health effects and costs of introduction and 1-dose switch delays, switching to nonavalent vaccine (9vHPV), supply disruptions, and various scale-up scenarios. Costs were evaluated from the health system perspective. We estimated cervical cancer cases, deaths, disability-adjusted life-years (DALYs), and program and health care costs. Results: Compared with no vaccination, maintaining current program performance would avert approximately 173,000 (95% UI: 149,000–191,000) cases and 2.7 (2.3–3.0) million DALYs across 2019 to 2100. A gradual scale-up of the current 2-dose quadrivalent vaccine (4vHPV) program would avert an additional 16,000 (14–18,000) cases (9%), increasing to 33,000 (28–37,000) cases (19%) if a multiage catchup is implemented in 2030. Accelerated scale-up of 1-dose bivalent vaccine (2vHPV) would avert 184,000 (164–199,000) cases and 3.0 (2.6–3.2) million DALYs, compared with no vaccination; translating to an additional 11,000 (2–17,000) cases averted (6%) compared with maintaining a 2-dose strategy, but at lower program ($81 million vs $76 million) and treatment costs ($2.09 billion vs $2.07 billion). HPV vaccination introduction in 2015 rather than 2019 would have averted an additional 74,000 (43%) cases. Annual vaccine supply disruptions translates to less than 9,000 (200–16,000) cases (5%) and 212,000 (74–305,000) DALYs averted (7%) compared with a 1-dose strategy. A 1-dose 9vHPV strategy would have more health benefits and save additional treatment costs compared with a 1-dose 2vHPV vaccine. Conclusions: Prompt 1-dose switch and rapid scale-up and adoption of a 9vHPV program should be priority policy decisions for Kenya. Graphical abstract
Valerian Mwenda, Joan-Paula Bor, Rose Jalang’o et al.· MDM Policy & Practice· 0 citations