Cost-effectiveness of introducing the conjugated pneumococcal vaccine to routine free immunizations for infants in Lazio, Italy

Objective To examine the health outcomes and costs of a hypothetical pneumococcal vaccination campaign among the general infant population in the Lazio region (Italy).Methods We developed a model simulating direct medical costs and health outcomes of vaccinating infants with conjugated pneumococcal vaccine (PCV-7) compared to the costs (in and outpatient) of treating the disease, from a public health service perspective. According to vaccine trials' outcomes, we considered vaccine effectiveness in preventing part of the invasive pneumococcal disease (IPD), pneumonia of any aetiology, and acute otitis moedia. Age-specific incidence, mortality and health care costs came from local surveillance and surveys; the vaccine costs [euro]40/dose. Annual budgetary impact and macro-health benefits were predicted for 2005-2014. Cost-effectiveness was expressed as net healthcare costs per disability-adjusted life-year (DALY) gained.Results After 10 years, five cases of meningitis, 20 IPD, 933 pneumonia, 406 pneumonia-related hospitalisations, and 3160 otitis cases would be averted annually by vaccinating. The annual cost of vaccination would be [euro]4.9Â m, and annual costs averted would be [euro]1.4Â m. Additional healthcare costs of a mass vaccination would decrease over time from [euro]5.1Â m to [euro]3.5Â m per year. At baseline, net cost per averted DALY was [euro]18.0Â k, if health benefits are not discounted, and [euro]51.7Â k adopting a 3.5% discount rate; it was 12% lower with a hypothesis of high IPD incidence and 68% lower if the vaccine cost 50% less.Conclusions The cost of the vaccine makes the campaign more expensive than today's recommended infant vaccinations. Nevertheless, the cost-effectiveness of introducing PCV-7 in Lazio compares favourably with previous estimates in similar countries.