Cost-effectiveness analysis of 20-valent anti-pneumococcal vaccination in the Spanish pediatric population

We evaluated the cost-effectiveness of implementingdifferent pneumococcal conjugate vaccines (PCV) – 20-valent (PCV20; 3 + 1), 13-valent(PCV13; 2 + 1), and 15-valent (PCV15; 2 + 1) – into the Spanish pediatric national immunizationprogram (NIP) for pneumococcal disease prevention. A Markov model adopting a Spanish National Healthcare Systemperspective and annual cycles estimated the health and cost impact of PCV20,PCV13, and PCV15 over 10 years among children. Epidemiological, cost, and utilityinputs were derived from published literature and official databases; vaccineefficacy inputs were based on PCV13 clinical effectiveness and 7-valent PCVefficacy and impact studies. Sensitivity analyses evaluated model robustness. PCV20 implementation was predicted to reduce the pneumococcaldisease burden, preventing > 1,000,000 pneumococcal disease cases and > 150deaths, versus both comparators. The adoption of PCV20 was estimated to result incost-savings of approximately €1 billion versus PCV13 and PCV15. PCV20demonstrated dominance over both alternatives, with 100% of 1,000 probabilisticsensitivity analysis iterations indicating PCV20 dominance. Incorporating PCV20 3 + 1 into the Spanish pediatricNIP was predicted to be more effective at a lower cost than PCV13 2 + 1 and PCV152 + 1 due to its broader serotype coverage and enhanced protection againstpneumococcal disease.