Project Summary:

Objectives:

- To estimate costs associated to pneumococcal disease (invasive bacterial disease, chest X-Ray confirmed pneumonia, and acute otitis media) in children under 5 years of age; and

- to conduct a cost-effectiveness evaluation of conjugate pneumococcal vaccine introduction in Brazil.

Methods:

A decision analytic model will be developed for cost effectiveness analysis of pneumococcal vaccine introduction, considering conjugate 7, 10, and 13-valent vaccines. Costs and effectiveness of two strategies (current strategy of vaccine use targeting high risk groups only, and alternative strategy of vaccine introduction into the routine EPI schedule and use in children) will be compared.

This study will be nested into a prospective population based surveillance study of invasive pneumococcal diseases and X-Ray confirmed pneumonia currently ongoing in Goiania, Brazil.

Outcomes considered in the model are: pneumococcal meningitis, pneumococcal sepsis, X-Ray confirmed pneumonia, and acute otitis media attributable to pneumococcus.

Vaccine effectiveness estimates and acute otitis media disease burden estimates will be obtained from literature review. Disease burden estimates (invasive bacterial disease and pneumonia) will be obtained from primary data collected from the prospective population based surveillance study ongoing in Goiania, Brazil. This study has been in place since May 2007 and data collection will be completed in May 2010. Population under surveillance include 53,000 children under 3 years of age.

Economic burden of disease will be obtained considering health care utilization costs observed during the prospective population based surveillance study. Indirect costs will be estimated considering secondary data sources.

Vaccine coverage estimates will be obtained from the National Immunization Programme considering DPT3 coverage. Immunization program costs will be estimated considering the bottom up ingredients approach, using secondary data from the National Immunization Programme. The model will take into consideration herd immunity estimates obtained from the literature.

The PAHO ProVac cost effectiveness model will be used. The perspectives of this analysis will be those of the Brazilian National Health System (SUS) and the society. Analytic horizon will be 20 years.

Number of deaths, life years lost, DALYs and QUALYs will be estimated. Cost effectiveness ratios per death averted, DALY and QUALY will be obtained.