Public Health and Economic Impact of transitioning to a 20-valent pneumococcal vaccine in Kazakhstan’s Pediatric National Immunization Program

Background/Objectives: Kazakhstan has implemented the 13-valent pneumococcal conjugate vaccine (PCV13) with a 2 + 1 dosing schedule in its pediatric National Immunization Program (NIP) since 2010. A 10-valent PCV (PCV10-SII) is registered and licensed in a 3 + 0 dosing schedule. Despite these efforts, the burden of pneumococcal disease (PD) persists. Recently, a 20-valent PCV (PCV20) was approved for infants aged six weeks and older in a 2 + 1 or 3 + 1 schedule. This study assesses the cost-effectiveness of switching to PCV20, and the impact of delaying its introduction in Kazakhstan’s NIP. Methods A decision-analytic Markov model estimated the cost-effectiveness of PCV20 versus PCV13 and PCV10-SII from a payer perspective. Costs and outcomes were discounted at 5.0% annually. Vaccine effectiveness of PCV20 was based on PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies. Epidemiologic and cost inputs were shared with Pfizer or sourced from publications relevant to Kazakhstan. Sensitivity and scenario analyses were conducted to assess the impact of variations in input parameters on the robustness of the results. Results Compared to PCV13 (2 + 1) and PCV10-SII (3 + 0), implementing PCV20 with either a 2 + 1 or 3 + 1 schedule is projected to avert a substantial burden of PD cases and deaths over 10 years, resulting in greater direct medical cost saving. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV10-SII. Results remained robust from sensitivity analyses and scenario assessments. Delaying PCV20 implementation in Kazakhstan’s pediatric NIP by 2 years would result in negative public health and economic outcomes. Conclusions Implementing PCV20 in Kazakhstan’s NIP could substantially reduce PD burden and associated healthcare costs, delivering greater public health and economic impact.