The National Committee for Immunisation Practice has recommended the health ministry to introduce Pneumococcal Conjugate Vaccine (PCV) into the routine immunisation services.

The vaccine prevents transmission of pneumococcal bacterial diseases such as pneumonia, otitis media, bacteraemia and meningitis in children under 5 years. The health ministry will submit a proposal to the Cabinet.

Director general of the department of medical services, Dr Pandup Tshering, said any new services or equipment that needs to be introduced in the country has to be looked after by the Essential Medicines and Technology Division (EMTD) with the health ministry.

“Before we introduce the vaccine, we first look at the disease burden,” Dr Pandup Tshering said. “Disease burden is based on the administrative data which means we are looking at the people who visit the hospital and get treatment.”

An economic evaluation was done for the first time with technical assistance from experts from the Health Intervention and Technology Assessment Program in Thailand.

A laboratory officer with EMTD, Pempa said that an economic evaluation was found necessary to guide evidence-based policy decision due to scarce resources and competing priorities in health,

Economic evaluation is the process of measurement and valuation of the costs and outcomes of two alternative choices – PCV 10 and PCV 13 available in the market, which has been proven cost effective in most countries.

Pempa said respiratory infections remain a major cause of morbidity and mortality of children in the country.

“The disease also contributes to high societal cost due to parent’s time away from work in order to provide informal care.”

A total of 10,891 pneumonia cases were reported in 2015 out of which almost 70 percent (7,572) were in children below 5 years.

Of the total 14,211 were acute otitis media, an ear infection caused by pneumococcal bacteria. About 2,575 of this infection were reported in children below 5 years. A total of 349 meningitis were reported the same year, of which, 102 were children below 5-year-old.

Pneumonia has claimed 325 lives while 135 died of meningitis in the last five years.

Pempa said the government spends huge resources on the treatment of Pneumonia, Otitis Media and Meningitis, especially among the children. “PCV is not used in many countries due to the high cost.”

Besides determining the cost utility of introducing PCV 10 or PCV 13 into routine immunisation programme, Pempa said that the study was conducted to estimate the budget impact and human resource impact of introducing the PCV and to inform policy and decision makers on the costs and associated benefits.

The Markov model is applied to estimate the costs and potential outcomes of each intervention in terms of Quality Adjusted Life Years (QALY).

Pempa said QALY measures the state of health of a person and incorporates both quality and quantity of life gained from an intervention.

The study found that compared to no vaccination, implementing either of the vaccines would prevent an estimate of 2,003 and 2,916 episodes of pneumococcal disease in the vaccinated population. “Further, 214 and 261 episodes of pneumococcal disease would be prevented in the unvaccinated populations due to herd protection.”

The study also found that an estimate of 28 and 42 pneumococcal deaths would be averted by introducing PCV10 and PCV13, respectively.

At the suggested threshold value, the maximum price of vaccine to be cost-effective is Nu 562 for PCV13 and Nu 513 for PCV 10.

A budget impact analysis was also conducted to determine the financial sustainability of vaccine introduction.

The budget analysis conducted over 5 year period considering the inclusion of PCV 10 or 13 in the routine immunisation services shows that about Nu 206.41M (million) is expected to be spent in the next five years as treatment cost of pneumonia and associated diseases if PCV vaccine is not introduced.

However, if introduced, the treatment cost is expected to decline by 8.5 percent and 13.6 percent respectively for PCV10 or PCV13.

The study recommends that both PC vaccines are cost effective and provide good value for money at the suggested threshold level of one GDP per capita equivalent to Nu 176,000.

“PCV 10 costs less than PCV 13 but if we implement PCV 13 we will be able to save more lives and the costs in long run,” Pempa said. “PCV could be considered for introduction at the current price and at the suggested threshold.”

The health ministry, World Health Organization and International Decision Support Initiative supported the study.

Dechen Tshomo


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