Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales

A. Melegaro, William Edmunds

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164 Citations (Scopus)


To establish whether universal vaccination of infants with the pneumococcal conjugate vaccine is likely to be cost-effective from the perspective of the health care provider (NHS).: Two hypothetical cohorts - one vaccinated and one unvaccinated - were followed over their lifetime, and the expected net costs and benefits (measured in terms of life-years and quality adjusted life years (QALY) gained) were compared in the two cohorts. The impact of indirect effects of the vaccine, such as herd immunity and serotype replacement, were investigated and their relative importance was assessed by performing univariate sensitivity analysis and multivariate Monte Carlo simulations.: Under base-case assumptions (no herd immunity and no serotype replacement) the programme is not expected to be cost-effective from the NHS perspective at the current price of the vaccine (assumed £30 per dose, three-dose programme). A reduction of the cost of the vaccine to half of its current level could bring the cost per QALY gained within normally acceptable ranges. If the burden of disease is significantly underestimated by current surveillance systems, then the cost per QALY gained approaches acceptable levels at the current vaccine price. Herd immunity may substantially reduce the burden of pneumococcal disease, particularly of pneumonia among the elderly, leading to a significant improvement in the cost per life year and QALY gained. Serotype replacement would partly offset these benefits, although only with a complete substitution of vaccine types with non-vaccine types and a low level of herd immunity, would pneumococcal vaccination programme would not be cost-effective.: Conclusions on the cost-effectiveness of pneumococcal conjugate vaccine are sensitive to assumptions regarding the current burden of pneumococcal disease and the future impact that vaccination will have in the unvaccinated and on the future serotype distribution. This study quantifies, for the first time, how these indirect effects may change the cost-effectiveness of pneumococcal vaccination.

Original languageEnglish
Pages (from-to)4203-4214
Number of pages12
Issue number31-32
Publication statusPublished - 22 Oct 2004

Bibliographical note

Funding Information:
We are grateful to Drs. Elisabeth Miller and Robert George for providing us with data from the national pneumococcal surveillance system (CDSC/RSIL). We thank Pauline Kaye and Patrick Oyeyemi for providing us with HES data and Dr. Mahein Hussein for allowing us to access unpublished data on the cost of meningitis cases. We would also like to thank the two referees of this journal for their valuable comments and suggestions. We thank the EU (QLG4-CT-2000-00640) and the Department of Health (121/7470) for financial assistance.


  • Cost-effectiveness
  • Economics
  • Pneumococcal conjugate vaccination
  • S. pneumoniae


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