OBJECTIVES: A cost-effectiveness analysis was conducted to assess the efficiency of implementing a PCV20 vaccination strategy in the Spanish pediatric population, for the prevention of non-bacteremic pneumonia (NBP), otitis media (OM) and invasive pneumococcal disease (IPD).

METHODS: A decision-analytic Markov model was developed to compare PCV20 in a 3+1 schedule with PCV13 or PCV15 in a 2 + 1 schedule over 10 years in pediatric population (0-17 years old) and from the Spanish National Healthcare System (NHS) perspective. Vaccine effect estimates (direct and indirect) were informed by PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies. Epidemiologic, clinical, health state utilities, utility decrements, cost per event, and ex-factory price discounting 7.5% (RDL8/2010) data were extracted from published literature and Spanish official databases. Clinical and economic (€,2023) outcomes related to invasive pneumococcal disease (IPD), hospitalized and non-hospitalized pneumonia, and otitis media (OM) were calculated for each strategy. A scenario analysis where PCV15 price was decreased 20% when compared to PCV20 was conducted.

RESULTS: Over 10 years, PCV20 versus PCV13 was estimated to avert over 2,107 IPD cases, 22,402 hospitalized and non-hospitalized pneumonia cases, 1,564,983 OM cases, and 214 deaths, resulting in cost savings of over 78,7 M€ and 16,851 more quality-adjusted life years. Compared with PCV15, PCV20 was estimated to avert 1,638 IPD, 17,049 NBP and 1,255,079 OM cases, and 167 deaths, while generating savings of 109,1 M€ and 13,292 additional QALYs (i.e. dominant strategy). In the scenario analysis, PCV20 resulted dominant vs PCV15 with 13,4 M€ in savings.

CONCLUSIONS: In the Spanish pediatric population, the vaccination strategy with PCV20 (3+1) is more effective and less costly (dominant) than both PCV13 and PCV15 (2+1). According to our results, PCV20 would provide the greatest benefit due to its broader serotype coverage, substantial incremental benefits and cost-savings.