Cutting third dose of PCV13 may reduce cost, increase disease burden

Eliminating the third dose from the 13-valent pneumococcal conjugate vaccine primary series increases savings but could cause a slight increase in disease, according to recent study findings published in Pediatrics.

“We found that eliminating the third dose in the primary series of PCV13 saved $421 million annually but would cause an estimated 2.5 additional deaths for a savings of $6 million per additional life year lost,” researchers wrote.

Emmanuel B. Walter

The study included a single birth cohort of 4.3 million children to evaluate cost savings and disease burden from removing the 6-month dose of PCV13 (Prevnar 13, Pfizer).

Researchers said that using two primary doses of PCV13 would save more than $400 million annually but would result inadditional deaths among inpatients with pneumonia or invasive pneumococcal disease. Removing the third dose given at 6 months of age would also result in an estimated 261,000 otitis media cases and 12,000 pneumonia cases annually. In total, savings per life-year lost would be $6 million. Nonfatal outcome savings would range from $143,000 to $4 million per additional quality adjusted life-years lost.

“Disease increases could be more than offset by moderate increases in coverage, although further investigation would be necessary to determine if the savings from removing one of the doses would exceed, equal, or fall short of the cost of interventions needed to increase coverage,” researchers wrote. “Examining the cost-effectiveness of alternative dosage regimens of pneumococcal and other new vaccines may be worthwhile for formulations with high costs per dose.”

Dennis A. Clements

In an accompanying editorial, Emmanuel B. Walter, MD, MPH, and Dennis A. Clements, MD, PhD, MPH, both of Duke University School of Medicine, wrote that, “Before contemplating a switch to a 3-dose series, it is important to remember the most serious diseases that PCV prevents and assure that the dosing schedule ultimately chosen is up to the challenge of preventing these infections.”

For more information:

Stoecker C. Pediatrics. 2013;doi:10.1542/peds.2012-3350.

Walter EB. Pediatrics. 2013;doi:10.1542/peds.2013-1573.

Disclosure: The researchers report no relevant financial disclosures.