Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia

Type Journal Article - Vaccine
Title Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia
Volume 35
Issue 7
Publication (Day/Month/Year) 2017
Page numbers 1055-1063

The Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.

The incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price.

The ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.


Introducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.

Pneumococcal conjugate vaccineCost-effectivenessMongoliaVaccineBudget impactPCV13
AMCadvance market commitmentAOMacute otitis mediaCFRcase-fatality riskDALYdisability-adjusted life yearGDPgross domestic productGNIgross national incomeHibhaemophilus influenzae type bICERincremental cost-effectiveness ratioIPDinvasive pneumococcal diseaseMNTMongolian tugrikMOHMinistry of HealthNPNMnon-pneumonia non-meningitisOOPout-of-pocketPAHOPan American Health OrganizationPCVpneumococcal conjugate vaccineWPRWestern Pacific region

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