Objective: The 20-valent pneumococcal conjugate vaccine (PCV; PCV20) was approved for paediatric vaccination against pneumococcal disease in Singapore in May 2024. We assessed the cost-effectiveness of PCV20 versus the current standard of care (13-valent PCV [PCV13]) and another licensed 15-valent PCV (PCV15), all under 2+1 schedules, in Singapore’s paediatric National Childhood Immunisation Schedule (NCIS).
Methods: Using Markov multiple-cohort model, clinical and economic outcomes associated with each vaccination strategy were estimated from a payer perspective (i.e., Singapore's Ministry of Health) with a 10-year time horizon and annual discounting rate of 3%. Both direct and indirect vaccine effects were considered. Singapore-specific data were prioritised as model inputs. Vaccine effectiveness was estimated from PCV13 effectiveness, 7-valent PCV (PCV7) trial and PCV7 and PCV13 impact studies. The vaccinated cohort comprised children aged <2 years. The cost-effectiveness of PCV20 versus comparators was evaluated using the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained. Sensitivity and scenario analyses tested the robustness of model assumptions and inputs.
Results: In the base case, PCV20 was estimated to prevent additional substantial numbers of pneumococcal disease cases and pneumococcal disease-associated deaths, leading to a QALY gain and approximately $60 million Singapore Dollars total cost-saving, versus PCV13 and PCV15 over 10 years. With greater health benefits and lower overall costs, PCV20 was the dominant strategy in both pairwise comparisons. Results from sensitivity and scenario analyses showed the robustness of the conclusion.
Conclusion: Implementing PCV20 2+1 into Singapore’s NCIS was estimated to be the cost saving strategy versus PCV13 2+1 or PCV15 2+1, providing improved health outcomes and medical cost-savings. These results support the emerging consensus that PCV20 implementation into paediatric vaccination programmes would result better outcomes.