Comment on: “Cost-Effectiveness Evaluation of the 10-Valent Pneumococcal Non-Typeable Haemophilus influenzae Protein D Conjugate Vaccine and 13-Valent Pneumococcal Vaccine in Japanese Children”

INTRODUCTION Shiragami and colleagues [1] have presented a cost-effectiveness model of the use of routine pneumococcal vaccination in infants in Japan using the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent pneumococcal conjugate vaccine (PCV13). In this analysis, the authors concluded that the routine use of PCV10 was more cost-effective than PCV13. While the analysis applies modeling methodologies that are sound, many of the assumptions presented in the paper are inconsistent with current published scientific evidence, specifically those regarding PCV13 effectiveness against serotype 3, PCV10 effectiveness against pneumonia, PCV10 effectiveness against otitis media, PCV10 cross-protection against serotypes not contained in the vaccine (serotypes 6 and 19A), and herd effects. We challenge these assumptions using previously conducted studies and data in the public domain. on immunologic criteria; no efficacy studies formed the licensure criteria. Therefore, early cost-effectiveness evaluations required extrapolation of immunogenicity to clinical effectiveness. We discussed the criteria under which appropriate assumptions could be formulated in a review paper [2]. In subsequent years, several efficacy and effectiveness evaluations have been conducted around the world to fully evaluate both vaccines. PCV10 data have been analyzed in 2 randomized controlled trials [3, 4], and PCV13 data have largely come from studies assessing the effectiveness of vaccination after introduction in national immunization programs initiated following the transition from the 7-valent pneumococcal conjugate vaccine (PCV7) to PCV13. Since the introduction of PCV13 in countries having a national immunization program, there has been