Economic and cost-effectiveness aspects of vaccines in combating antibiotic resistance

Publication summary

Investment in the development and introduction of vaccines for bacterial diseases may be inhibited by the lack of data demonstrating that vaccines are a cost-effective way of preventing and slowing antimicrobial resistance (AMR) in comparison with other interventions. Despite a growing body of evidence that affirms the link between vaccines and AMR prevention, a lack of cost-effectiveness studies—and the country-level costing, AMR, and antibiotic use data that inform them—may mean that vaccines are not seen as a valuable part of AMR work. This literature review assessed two studies that directly estimated AMR costs averted due to pneumococcal vaccine use in China and Ethiopia, as well as a series of cost-effectiveness studies for immunization in the context of AMR, for vaccines in development and under license as of June 1, 2022.

Who this is for

• Vaccine developers
• Health economists
• National health agencies

Key findings

Studies directly linking averted AMR to vaccines

The researchers identified two studies, one each from China and Ethiopia, that modeled averted AMR costs and/or resource use associated with pneumococcal vaccines. Studies incorporated data on vaccine coverage, pneumococcal disease incidence, care-seeking behavior, and antibiotic use, and modeled the probability that a resistant or susceptible strain would survive antibiotic exposure.

China. A study that modeled the effects of pneumococcal vaccines on AMR (measured with direct medical and non-medical costs, productivity losses for caregivers, and productivity loss due to death and disability) in China from 2021 to 2026 found that a scaled 5-year increase of vaccination coverage to 99% would save $371 million over the time period. (NB: The study used a 2014 estimate of 4.74% pneumococcal vaccination coverage among children as a baseline.) 

When modeling the use of an accelerated increase in vaccination coverage to 85% in the first 2 years, followed by 3 years of steadily increasing coverage to 99%, cost savings rose to $5.86 million.

When death and disability were factored into the model, the scaled approach saved an additional $37 million, and the accelerated approach saved an additional $67 million.

Ethiopia. A study of costs averted from antibiotic treatment failure and AMR-related deaths in Ethiopia from 2011 to 2017 found that pneumococcal immunization was associated with $32.7 million in cost savings. When vaccination coverage of 68% was modeled, annual cost savings were estimated to reach $7.67 million over 5 years, and cost savings grew to $11.43 million under a scenario of 85% vaccine coverage.

Cost-effectiveness research in the context of AMR

All 12 of the cost-effectiveness assessments identified as part of this literature review studied the cost-effectiveness of pneumococcal vaccines in the context of serotype replacement (ie, the increase in non-vaccine serotypes that often accompanies the introduction of a vaccine). Serotype replacement can often be a harbinger of the emergence of antibiotic-resistant serotypes, especially with pneumococcal disease.

Most of the studies found that pneumococcal vaccination was cost-effective in the context of serotype replacement, and two studies that determined that the vaccine wasn’t cost-effective in this scenario also noted that challenges like the price of the vaccine, rather than serotype replacement, were responsible for the findings.

The researchers highlighted a study of pneumococcal vaccine coverage across 77 countries, which found that the 7-valent vaccine was cost-effective for 53 countries, even in the context of serotype replacement. Only one country—Seychelles—had a negative cost-effectiveness ratio associated with pneumococcal vaccine coverage, which was attributed to the fact that disability-adjusted life years (DALYs) associated with serotype replacement were greater than DALYs averted through vaccination.

Evidence gaps and recommendations for measuring the cost-effectiveness of vaccines against AMR

Studies that evaluate the clinical and economic performance of vaccines against or in the context of AMR are only as robust as the data they use to model the effects of vaccination. More country-specific data on AMR, antibiotic use for vaccine-preventable infections, and the emergence and prevalence of resistance genes will enable studies of vaccine cost-effectiveness that are capable of better estimating disease burden and the cost of illness.

Because estimates of the costs attributable to AMR come mainly from hospital data in high-income countries, a framework on how to measure AMR costs and use them to assess the cost-effectiveness of interventions from the societal perspectives of diverse groups is urgently needed. 

All of the research identified by this literature review focused on the impact of pneumococcal vaccination, and cost-effectiveness studies are needed to better understand the effects of other bacterial vaccines, such as those for typhoid, Haemophilus influenzae type b, and tuberculosis, as well as other diseases where cost-effectiveness research can help with AMR resource allocation.