The population impact and cost-effectiveness of the 10-valent pneumococcal conjugate vaccine in Iceland

• Main Author: Eyþórsson, Elías
• Other Authors: Ásgeir Haraldsson, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2019
• Subjects: Streptococcus pneumoniae; Pneumococcal conjugate vaccines; Cost-effectiveness analysis; Otitis media; Herd immunity; Eyrnabólga; Nefkok; Bólusetningar; Bóluefni; Læknisfræði; Doktorsritgerðir; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/1179

Streptococcus pneumoniae is a Gram-positive diplococcus that is both a commensal bacterium in the upper respiratory tract of humans, and a common pathogen. The infectious manifestations of pneumococci span a range from benign to serious; from acute otitis media (AOM) that often resolves without intervention, to sepsis and meningitis which invariably require hospitalization. Despite its often benign course, AOM is the most common reason for physician visits and antimicrobial prescriptions in children. Likewise, tympanostomy tube placements are the most common surgical procedure requiring general anesthesia in children. Pneumococcal vaccinations have a long history, beginning in 1914 with clinical trials in humans. A 23-valent polysaccharide vaccine was marketed in 1983, but was poorly immunogenic in children. The seven-valent pneumococcal conjugate vaccine became available in 2000. Multiple studies have demonstrated that it offered protection against AOM, tympanostomy tube placements, pneumonia and invasive disease in children. Indirect protection in adults has also been demonstrated. Higher valency vaccines were later developed. In April of 2011, the 10-valent pneumococcal Haemophilus influenzae Protein D conjugate vaccine (PHiD-CV10) was introduced in Iceland. The aim of the study was to evaluate the impact of PHiD-CV10 introduction in Iceland. Special attention was paid to the healthcare burden of children: visits to primary care and to the emergency department of Children‘s Hospital Iceland for AOM, antimicrobial prescriptions, tympanostomy tube placements, and hospitalizations for pneumonia and invasive disease. The population-based impact of PHiD-CV10 was examined, including whether herd effect occurred in adults. Finally, the study focused on estimating the cost-effectiveness of PHiD-CV10 in Iceland. Individual level data were obtained from five population-based registries and Landspitali University Hospital‘s patient registry for the period from 1 January 2005 to 31 December 2017. Data on all administered ...