Economic analysis and public 

health impact of PCV15 use 

among children in the US

Advisory Committee on Immunization Practices

June 22, 2022

Andrew J. Leidner

Immunization Services Division

CDC/NCIRD

1
Acknowledgements

• This presentation summarizes work conducted by two groups

• CDC model team

• Charles Stoecker, Miwako Kobayashi, Namrata Prasad

• Merck model team

• Min Huang, Tianyan Hu, Jessica Weaver, Kwame Owusu-Edusei

2

The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the 

views of the Centers for Disease Control and Prevention. 
Conflict of interest statements

• Andrew J. Leidner: None

• CDC model team: None

• Merck model team: Merck manufacturers the PCV15 vaccine

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Terminology

Abbreviation Full term / description

IPD Invasive pneumococcal disease

NBP Non-bactaeremic pneumonia

AOM Acute otitis media

PCV7 Pneumococcal conjugate vaccine, 7 serotypes

PCV13 Pneumococcal conjugate vaccine, 13 serotypes

PCV15 Pneumococcal conjugate vaccine, 15 serotypes

QALY Quality-adjusted life-year

CER Cost-effectiveness ratio

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Background

• Pneumococcal vaccination (i.e., PCV7) of children has averted 

thousands of deaths and saved millions of dollars in direct medical 

costsa

• PCV13 (vs PCV7) was estimated to be cost-savingb,c

• Two models have been used to examine the costs and benefits of 

including PCV15 as an option in the childhood immunization schedule

• CDC model, Merck model

• The two models went through the CDC economic review, following the 

ACIP Guidance for Health Economic Studiesd

5

a. Zhou et al. 2014. 

b. Messonnier et al. 2009. 

c. Rubin et al. 2010. 

d. Leidner et al. 2019. 
Outline

• Study questions

• Cost-effectiveness results

• Prevented disease burden

• Discussion

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Study questions

• What is the cost-effectiveness and public health impact of including 

PCV15 as an option in the immunization schedule for children?

• What is the cost-effectiveness of vaccinating children with PCV15 compared 

to vaccinating children with PCV13?

• What is the disease burden that can be prevented by vaccinating children 

with PCV15 compared to vaccinating children with PCV13?

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Key assumptions for the cost-effectiveness 

analyses in the two models

• Vaccine effectiveness

• PCV15 and PCV13 have same VE for PCV13-type disease

• PCV15 provides protective VE for two additional serotypes

• Vaccine costa

• The average cost for PCV15 is less than the cost of PCV13

a. Detailed information on these inputs are available in a supplemental slide. 8
Cost-effectiveness results

PCV15 vs. PCV13

Model scenarios CDC model Merck model

Base case results Cost-saving Cost-saving

Scenarios and sensitivity analyses

Including scenarios with PCV15 public price set highera than in base case All cost-saving All cost-saving

• Both models found that PCV15 is cost-saving compared to PCV13

• “Cost-saving” means total costs are reduced and health outcomes are improved

• This result is not surprising, given the assumptions

• PCV15 prevents more disease than PCV13 

• PCV15 costs approximately the samea as PCV13

a. Both models explored the impact of higher vaccine dose cost, with the public price was set 5% and 2.5% higher than the base case, for the CDC and Merck models, respectively. Detailed 

information on these inputs are available in a supplemental slide. In the base case of both models, PCV15 costs less than PCV13 on average. In the scenarios with higher PCV15 public price, the 

cost of PCV15 was greater than PCV13 on average. These scenarios were found to be cost-saving overall, due to the additional reduced direct medical costs from prevented disease 9burden that 

was associated with the two additional serotypes included in PCV15.
Additional assumptions in the two models

Model characteristics CDC model Merck model

Model type Single cohort

Multi-cohort

• Includes all ages 0-100

• No adult vaccinations

• New births added every year

• Single cohort investigated in scenarios.

Model duration (years) 17 100

Incidence ratesa Higher for inpatient NBP Higher for IPD, outpatient NBP, 

and AOM

a. Differences in incidence rates between the two models explain some of the differences in estimated prevented disease burden. Incidence rates in both models were age-adjusted, the term

“higher” is used to broadly characterize the incidence assumptions relative to the other model. More detailed information on incidence inputs are available in a supplemental slide10. IPD refers to

invasive pneumococcal disease, NBP refers to outpatient or inpatient non-bactearemic pneumonia, AOM refers to acute otitis media.
Results, prevented disease burden

PCV15 vs. PCV13

Model, scenario Population 

structure

IPDa NBPa AOMa Deaths QALYsa

gained

CDC model,

base case Single cohort 220 3,900 80,600 22 760

Merck model,

single cohort scenario Single cohort 490 10,100 108,000 42 1,300

Merck model,

base case Multi-cohort 61,000 306,000 3,500,000 6,500 96,000

a. IPD refers to invasive pneumococcal disease, NBP refers to total (outpatient and inpatient) non-bactearemic pneumonia, AOM refers to acute otitis media, QALYs refers to quality11-adjusted lifeyears.
Results, prevented disease burden

PCV15 vs. PCV13

• If one cohort of infants received PCV15 instead of PCV13a

Prevented outcomes Range

IPD 220 to 490

NBP 3,900 to 10,100

AOM 80,600 to 108,000

Deaths 22 to 42

• Considerations

• The benefits of vaccinating multiple cohorts would be greater

• If adoption of PCV15 is lowera, then total benefits would be smaller

• If indirect effects from the vaccinated cohort to older individuals were included, then 

total benefits would be greater

• Indirect effects may be modest if adult PCV15/PCV20 use is high and if indirect effects take a 

few years to develop

a. Both models assume PCV15 entirely replaces PCV13 under a given strategy with 4th dose vaccination coverage rate equal to 82%. Hypothetically, the use of PCV15 may only repla12ce a portion of 

PCV13 use and therefore both vaccines could be in use at the same time.
Discussion & Conclusions

• Pneumococcal vaccination of children has been found to reduce direct 

medical costs and improve healtha

• PCV13 (vs. PCV7) was estimated to be cost-saving in previous studiesb,c

• PCV15 (vs. PCV13) was estimated to be cost-saving in models presented today

• Models assume PCV15 prevents more disease than PCV13, PCV15 costs approximately the 

same as PCV13

• Pneumococcal vaccination of children may have a notable health impact

• Vaccination of children with PCV15 (vs PCV13) may prevent thousands of cases of 

IDP, NBP, AOM

• Models assume that PCV15 VE is equal to PCV13 VE for PCV13-type disease, and provides 

protection for two additional, non-PCV13 serotypes

• Differences across models in prevented disease burden are due to differences in model 

structure and input values

• CDC model is more conservative than the Merck model

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a. Zhou et al. 2014. 

b. Messonnier et al. 2009. 

c. Rubin et al. 2010. 
Acknowledgements

• This presentation summarizes work conducted by two groups

• CDC model team: Charles Stoecker, Miwako Kobayashi, Namrata Prasad

• Merck model team: Min Huang, Tianyan Hu, Jessica Weaver, Kwame OwusuEdusei

• CDC colleagues: 

• Fangjun Zhou, Harrell Chesson, Jamie Pike, Bo-Hyun Cho, Yuping Tsai, Shannon Stokley

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The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent 

the views of the Centers for Disease Control and Prevention. 
References

• Leidner AJ, HW Chesson, MI Meltzer, ML Messonnier, GM Lee, and LA Prosser. 2019. 

Guidance for health economics studies presented to the Advisory Committee on 

Immunization Practices (ACIP), 2019 update. Centers for Disease Control and Prevention, 

Atlanta GA, October 11, 2019: 1-21.

• Messonnier ML, F Zhou, and P Nuorti. 2009. Cost-Effectiveness of Using 13-valent 

Pneumococcal Conjugate Vaccine in Infants and Young Children to Prevent Pneumococcal 

Disease in the United States. Meeting of the Advisory Committee on Immunization Practices, 

October 21-22, 2009. Atlanta GA.

• Rubin JL, LJ McGarry, DR Strutton, KP Klugman, SI Pelton, KE Gilmore, and MC Weinstein. 

2010. Public health and economic impact of the 13-valent pneumococcal conjugate vaccine 

(PCV13) in the United States. Vaccine 28: 7634-7643.

• Zhou F, A Shefer, J Wenger ML Messonnier, LY Wang, A Lopez, M Moore, TV Murphy, M 

Cortese, L Rodewald. 2014. Economic Evaluation of the Routine Childhood Immunization 

Program in the United States, 2009. Pediatrics 133(4): 577-585.

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Vaccine cost, model inputs

Model characteristics CDC model Merck model

Vaccine 

costs

PCV13

Public, $151

Private, $226

PCV15 

Public, $151 (up to $158)a

Private, $216

PCV13

Public, $150

Private, $226

PCV15

Public, $154 ($150 to $158)a

Private, $215

a. In both models the public price of PCV15 could vary up to 5% greater than public price of PCV13. The base case of the Merck model assumed the public price of PCV15 would be 2.5% greater 

than the public price of the PCV13 vaccine.

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Vaccine effectiveness and indirect effects, 

model inputs

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Model 

characteristics CDC model Merck model

Vaccine 

Effectiveness 

(direct protection)

PCV15 and PCV13 have same VE 

for PCV13-type disease

PCV15 has protective VE against 

two additional serotypes

PCV15 and PCV13 have same VE 

for PCV13-type disease

PCV15 has protective VE against 

two additional serotypes

Indirect effectsa

7.8% reduction per year for all

PCV15-only disease outcomes 

(i.e., IPD, NBP, AOM), applied to 

single cohort until age 17 years

7.8% reduction per year for just 

IPD that is PCV15-only type 

In the base case, this is applied to 

all cohorts including elderly at the 

beginning of the model and 

vaccinated infants as they age

a. Because indirect effects were incorporated as a percent reduction that are independent of vaccination coverage, these models would not be considered dynamic transmission models.
IPD incidence, model inputs

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Age CDC model Merck model

0-1 10-14 10-13

2-17 1-5 2-4

18-49 NA 3-7

>= 50 NA 17-24
NBP incidence, model inputs

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Outpatient NBP 

(per 100,000)

Age CDC model Merck model

0-1 1,400-2,800 2,900

2-4 1,100-2,700 3,400

5-8 560-1,100 1,300

9-17 500 1,300

Inpatient NBP 

(per 100,000)

Age CDC model Merck model

0-1 490-680 340

2-4 190-450 170

5-8 84-170 45

9-17 75 45
AOM incidence, model inputs

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Model characteristics CDC model Merck model

AOM incidence (per 100k)

62-65,000 for age 0-1 years

39,000 for age 2-4 years

0.0 for age 5-17 years

74,000 for age 0-1 years

41,000 for age 2-4 years

8,000 for age 5-17 years