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Beyond Serotypes: Updated Evidence of Comparable Impact and Cost Effectiveness of PHID-CV (Synflorix) and 13

03 Oct 2020
When there is more than one option, how do you decide which vaccine to give to your patients?

Several factors are considered such as safety, suitability, number of doses and, most important, efficacy. One easy way of determining vaccine efficacy is by paying attention to serotype content including the kinds and number of serotypes covered. That is, one may easily conclude that a vaccine that contains more strains will have better efficacy versus a vaccine with less.

Such an approach to comparison, however, may not always hold true especially when vaccines interact in the real-world setting. Disease impact and effectiveness provide a perspective on what we call “overall protection” which goes beyond common assumptions on serotype content.

Last February 2019, the World Health Organization (WHO) concluded in its position paper that pneumococcal conjugate vaccines (PCV) in general are effective, safe and recommended to be included in childhood immunization programs around the world. They also made an interesting finding between the existing higher-valent PCVs—PHID-CV (Synflorix) and PCV13.

PHID-CV (Synflorix) or PCV 10 contains ten (10) serotypes while PCV13 has an additional three on top of the shared ten. Although there is a difference in the number of serotypes, recent real-world evidence has found Synflorix to be comparable with PCV13 in terms of overall pneumococcal disease impact.

Comparable Impact


In a systematic review of various literature, WHO has found that there is currently inadequate evidence to establish any difference between the impact of PHiD-CV and PCV13 on overall disease burden despite the inclusion of 3 additional serotypes in PCV13.

Having the additional three serotypes can translate to higher geometric mean concentration (GMC) and higher percentage of responders versus a PCV that does not contain the same. However, it should be noted that antibody responses against 19A were also observed in Synflorix likely due to cross-reactivity with vaccine serotype 19F. (WHO 2019, 95)2

“In summary, PCV10 and PCV13 have comparable immunogenicity and impact on IPD, pneumonia and NP carriage due to shared vaccine serotypes. While differences were found in their immunogenicity and impact on the 3 serotypes included in PCV13 and not PCV10 and on serotype 6c, there is currently insufficient evidence that the 2 vaccines differ in their impact on overall pneumococcal disease burden.” (WHO 2019, 97)2  

Invasive Pneumococcal Disease (IPD)

The review found that both PHID-CV (Synflorix) and PCV13 have significant impact in decreasing vaccine-type IPD and that no advantage in IPD protection could be attributed to the three additional serotypes in PCV13.

“Although no head-to-head studies of the impact or effectiveness of the 2 products on IPD outcomes have been reported, the available evidence indicates that both products are effective in reducing overall vaccine-type IPD in both vaccinated and unvaccinated individuals. Although PCV13 contains 3 additional serotypes, there is currently insufficient evidence to determine whether they change the impact on overall IPD burden (vaccine-type and non-vaccine-type disease combined)."2


Pneumonia

Looking at disease impact, the two PCVs were effective in protecting against pneumonia both directly (those who benefited from receiving a dose) and indirectly (those who benefited but did not receive a dose).

“Both PCV10 and PCV13 had direct and indirect effects against pneumonia; however, as there are no comparative studies, there is no evidence of a difference in impact. No conclusions could be drawn about a differential impact on mortality by product.” (WHO 2019, 96)

Nasopharyngeal Carriage

In terms of NP carriage (which is a sign of potential indirect effects of vaccination), there was limited evidence to conclude any difference in impact between the two PCVs including mixed results for serotype 3.

“Limited evidence was available from head-to-head studies on the differential impact or effectiveness of PCV10 and PCV13 on NP carriage. Both products reduced carriage of the serotypes common to both vaccines, but studies of individual products could not be compared quantitatively because of substantial confounding by schedule, local epidemiology and prior PCV7 use in the community.”2

Download & read the full WHO position paper


Cost-Effectiveness

Aside from overall impact to disease, the same report also made its position on cost-effectiveness which found Synflorix and PCV13 to be both cost-effective vaccines for health care providers and society. On which PCV is more economical, WHO suggested that it would depend on unique country characteristics such as coverage rates at different schedules and which serotypes are prevalent.  

In the case of Philippines, a recent health economic evaluation presented in the Pediatric Infectious Disease Society of the Philippines (PIDSP) convention poster session last February 2020 concluded PHID-CV (Synflorix) to be more cost-effective in the context of an Expanded Program on Immunization (EPI) versus PCV13.

Apart from the WHO systematic review findings, the analysis incorporates updated evidences and the inclusion of the 19A indication in the label update of Synflorix in the country. This was done to come up with an updated cost-effectiveness analysis that considers new evidence in the landscape of PCVs. 

Updated vaccine prices and other assumptions were applied to a Markov cohort model that was used in a 2015 cost-utility analysis of PCVs in the Philippines. It measured cost-effectiveness of two scenarios: PCV13/PHID-CV versus no vaccination and PCV13 versus PHID-CV.

Results of the analysis showed that (1) both vaccines are cost-effective versus no vaccination and (2) that Synflorix offers better value for the Philippines compared to PCV13 at publicly available prices. In the context of an EPI, an estimated Php 500 million in government savings can be achieved which can be used for other health care needs such as expanding current programs or adding an additional antigen in the EPI.

Cost-Based Decisions

At a time of financial stress across socio-economic classes caused by the global pandemic, choosing a cost-effective vaccine provides a helping hand to parents as they begin their gradual restart into society. For instance, the choice of PCV multiplied by the dosing schedule will determine the level of cost savings that they can allocate for other needs such as money for their child’s other health priorities.

When assessing which PCV to give, it is imperative to go beyond the number of serotypes and take a holistic view of each vaccine’s merits. An awareness of present evidence on comparable efficacy, suitability and safety allows for cost-based decisions that do not compromise quality of protection against pneumococcal disease and leave more savings in parents’ pockets.

To gain access to GSK Vaccines, download the GSK VaxSmart App! See the links below:

Vaxsmart

Google Play2    Applestore2
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Most Read Articles
5 days ago
Gingival bleeding appears to influence the association between periodontal diseases and blood pressure (BP), a study has shown. However, the burden represented by periodontitis is still vital. Periodontal assessment may be essential in difficult to control hypertension.
Jairia Dela Cruz, 05 Oct 2020
Drinking more than two cups of coffee per day may just be the intervention that prevents hundreds of thousands of liver disease‐related deaths globally, a study reports.
Pearl Toh, 21 Sep 2020
Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.
04 Oct 2020
Treatment with antivascular endothelial growth factor (anti-VEGF), along with regular monitoring, minimizes the risk of long-term vision loss in patients with neovascular age-related macular degeneration (AMD), a recent study has shown.