Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines

PLoS One. 2015 Jul 1;10(7):e0131156. doi: 10.1371/journal.pone.0131156. eCollection 2015.


Objectives: The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies.

Methods: A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty.

Results: With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program.

Conclusion: The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis*
  • Female
  • Financing, Government
  • Humans
  • Immunization Programs / economics*
  • Income
  • Infant
  • Infant, Newborn
  • Male
  • Markov Chains
  • Middle Aged
  • Philippines
  • Pneumococcal Vaccines / administration & dosage
  • Pneumococcal Vaccines / economics*
  • Pneumonia, Pneumococcal / immunology
  • Pneumonia, Pneumococcal / microbiology
  • Pneumonia, Pneumococcal / prevention & control*
  • Streptococcus pneumoniae / drug effects
  • Streptococcus pneumoniae / immunology
  • Vaccination / economics*
  • Vaccines, Conjugate


  • 10-valent pneumococcal conjugate vaccine
  • 13-valent pneumococcal vaccine
  • Pneumococcal Vaccines
  • Vaccines, Conjugate

Grant support

This work was supported by the Rockefeller Foundation, the National Institute for Health and Care Excellence (NICE) International, World Health Organization (WHO), Health Intervention and Technology Assessment Program (HITAP), and the Department of Health Philippines. The views expressed in the publication are those of the authors and not necessarily those of the supporting institutions. WHO and Rockefeller Foundation had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.