Evaluación económica de vacunas neumocócicas conjugadas para Chile

Objective: To determine the cost-effectiveness of conjugated pneumococcal vaccines, PHiD-CV and PCV-13, for Chile. Materials and methods: We evaluated the cost effectiveness of both vaccines for Chile. Community acquired pneumonias (CAP; hospitalized and outpatients), invasive pneumococcal diseases (IPD; hospitalized bacteremia, meningitis and its sequelae) acute otitis media (AOM; medical visits and myringotomies), and PAHO revolving fund 2012 vaccine prices were considered in the analysis. The model assesses the medical and economic impact of both vaccines over a newborn cohort during a lifetime. Univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of our cost effectiveness result were performed. Results: We estimate that these vaccines can prevent 15,000 CAPs, 92-96 pneumococcal meningitis, 101-105 hospitalized pneumococcal bacteraemias and 21,000-28,000 AOMs per vaccinated cohort. PCV-13 showed additional benefits on IPD, while PHiD-CV showed additional benefits on AOM. PHiD-CV prevents 142 million pesos more than PCV-13 on treatment costs, and the vaccine costs 745 million pesos less. The cost utility analysis shows that both vaccines are cost effective for Chile. PHiD-CV generates 19 more quality adjusted life years (QALYs) than PCV-13 at a lower cost (-849 million pesos), being dominant in the deterministic analysis. PSA shows PHiD-CV is less costly than PCV-13 in 100% of the replicas, confirming the robustness of our estimations. Conclusions: In our analyses, both vaccines demonstrate reduction in the burden of pneumococcal disease, as well as cost effectiveness for Chile. PHiD-CV appears more cost effective, saving 849 million pesos per vaccinated cohort versus PCV-13.Objetivo: Evaluar costo-efectividad (CE) de las vacunas conjugadas neumocóccicas, PHiD-CV y PCV-13 para Chile. Material y método: Se evaluó la CE de ambas vacunas. Se consideraron la neumonía adquirida en la comunidad (hospitalizadas y ambulatorias), enfermedad neumocóccica invasiva (ENI; bacteremia hospitalizada, meningitis y sus secuelas) otitis media aguda (OMA; ambulatorias y miringotomías), y precios por dosis del fondo rotatorio de OPS 2012. Se determinó el impacto médico y económico de ambas vacunas siguiendo una cohorte chilena por toda la vida. Se realizó un análisis de sensibilidad univariado y probabilístico (ASP) para evaluar la robustez de las estimaciones de CE generadas. Resultados: Se estimó que estas vacunas pueden prevenir unas 15 mil neumonías, 92-96 meningitis neumocóccicas, 101-105 bacteremias neumocóccicas hospitalizadas y 21 mil a 28 mil OMAs por cohorte vacunada. PCV-13 mostró beneficios adicionales en ENI mientras que PHiD-CV presentó beneficios en OMAs. PHiD-CV previno 142 millones de pesos más que PCV-13 en tratamientos médicos y la vacuna costó 745 millones menos. El análisis de costo-utilidad mostró que ambas vacunas son CE para Chile. PHiDCV generó 19 AVACs más que PCV-13 a un menor costo (-849 millones de pesos), siendo dominante en el análisis determinístico. El ASP mostró que PHiD-CV fue menos costosa que PCV-13 en 100% de las replicas, respectivamente, confirmando que los resultados generados fueron robustos. Conclusiones: Ambas vacunas reducirían la carga por enfermedad neumocóccica significativamente y serían altamente CE para Chile. PHiD-CV sería más CE y ahorraría 849 millones por cohorte vacunada versus PCV-13

Neonatal meningitis caused by atypical Streptococcus pneumoniae: Case report and review Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. Traditionally, S. pneumoniae is identified in the laboratory by demonstrating susceptibility to optochin. However, the emergence of optochin-resistant organisms makes definite identification difficult when only phenotypic tests are taken as markers. We present the case of a severe early-onset neonatal meningitis due to an atypical strain of S. pneumoniae. Laboratory methods utilized to certify this species diagnosis are discussed. © 2006 Sociedad Chilena de Infectología