Background

Vaccination of children in developing countries against pneumococcal infection has great potential to save lives and reduce disability. The pneumococcus (Streptococcus pneumoniae) is the leading bacterial cause of acute lower respiratory infections, which in turn, are a major cause of child mortality. It also causes meningitis, other forms of invasive bacterial disease, and ear infections (acute otitis media).

Routine vaccination of infants against pneumococcus needs substantial investment by governments, non-governmental organizations, and donors.

Financial barriers to pneumococcal conjugate vaccine (PCV) have begun to fall. The GAVI Alliance decision to invest an initial $200 million to help a group of countries introduce pneumococcal conjugate and rotaviral vaccines was announced in November 2006, the same month that the International Finance Facility for Immunization issued its inaugural bonds. The announcement of an Advanced Market Commitment (AMC) of $1.5 billion for advancement of pneumococcal vaccines wasmade in February 2007. As pneumococcal conjugate vaccine becomes financially accessible, policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering how to spend healthcare dollars.

The Interactive Pneumococcal Vaccination Model addresses the need for streamlined cost-effectiveness analysis tools to assist decision makers in understanding the econdomic and health benefits associated with vaccine introductions.

The Model

This Interactive Pneumococcal Vaccination Model allows the health benefits, costs, and cost-effectiveness of pneumococcal vaccine to be projected according to an evidence-based approach. It is designed for users with familiarity using personal computers but with limited experience conducting health economic analyses. Wherever possible, the model is pre-populated with inputs drawn from the highest quality data sources. The model combines the results from three recent international efforts to assess the burden of pneumococcal disease and to develop standards for assessing the cost-effectiveness of health prevention:

WHO - Choosing Interventions that are Cost-Effective (WHO-CHOICE): WHO-CHOICE has assembled country-level data on the direct medical costs associated with hospital and outpatient management of diseases.

Global Serotype Project: Collecting unpublished and published sources of pneumococcal serotype data from across the globe, the GSP investigators have developed contemporary estimates of the regional proportions of disease-causing pneumococcal isolates covered by pneumococcal conjugate vaccines in children under age five.

WHO- Hib and Pneumococcal Global Disease Burden Project: The project investigators modeled credible country-level estimates of Haemophilus influenzae type B and pneumococcal disease burden in children under five, in order to understand the importance of disease due to these bacterial pathogens and the potential for control through vaccination.

Assumptions

1. The tool will not be used for commercial purposes, for nonprofit use only, available without charge.
2. Users take responsibility for all modifications made to the pre-populated model inputs. Using expert guidance, the tool has been pre-populated with the evidence from high quality, recognized sources. Users who choose to modify model inputs should seek their own expert guidance in identifying high quality and unbiased sources of information.
3. Limited technical support is available. However, the model is intended to be freestanding. We encourage users to seek local sources of expertise in using the tool. Questions regarding technical problems can be addressed to the PneumoADIP and development teams.

Expert Review Panel and Participants

The Interactive Pneumococcal Vaccination Model was developed through an expert panel process. The panel reached consensus on the key assumptions about epidemiology, vaccine efficacy, costs and model outputs projecting the cost-effectiveness of pneumococcal conjugate vaccine for infants in GAVI-eligible countries. Members of the panel were chosen for their expertise in pneumococcal epidemiology, vaccine-related health economics, public health, or preventive medicine in GAVI-eligible settings.

Expert Panelists Dagna Constenla, PhD Economic consultant Fort Collins, CO, USA Felicity Cutts, PhD Professor Emeritus Infectious Disease Epidemiology Unit London School of Hygiene and Tropical Medicine Provence, France Adam Finn, MD David Baum Professor of Paediatrics; Head, Unit of Child Health, Dept. Clinical Sciences at South Bristol Institute of Child Life & Health, University of Bristol Bristol, UK Andrew Pollard, MD Reader in Paediatric Infection and Immunity; Consultant in Charge of the Oxford Vaccine Group; Head of the Paediatric Infection and Immunity Laboratory Department of Paediatrics, University of Oxford John Radcliffe Hospital Oxford, UK G. Tom Ray, MBA Senior Analyst Division of Research Kaiser Permanente Oakland, CA, USA Cyndy Whitney, MD MPH Acting Chief Respiratory Diseases Branch, National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, GA, USA

GAVI's PneumoADIP Team http://www.preventpneumo.org Rabia Akram MPH, MBA Research Project Manager Julie Buss, MPH Communications Manager Michelle Moncrieffe-Foreman Communications Manager H. Benedicta Kim Manager, Communications Team Maria Deloira Knoll, PhD Director of Research Orin Levine, PhD Executive Director Farzana Muhib, MPH MALD Research Project Coordinator, Research Team Kate O'Brien MD, MPH Deputy Director of Research

Investigators/Development Team C. Greg Hagerty, PhD Assistant Professor of Medicine UMDNJ - Robert Wood Johnson Medical School New Brunswick, NJ USA cgreg@cgreg.com Anushua Sinha, MD MPH Assistant Professor of Preventive Medicine and Community Health UMDNJ - New Jersey Medical School Newark, NJ USA Frank Sonnenberg, MD Professor of Medicine, Associate Director of Clinical Informatics UMDNJ - Robert Wood Johnson Medical School New Brunswick, NJ USA