Background: The 13-valent pneumococcal conjugate vaccine (PCV13) has been included by the German Standing Committee on Vaccinations for infants since 2009, resulting in major reductions in pneumococcal disease (PD). Higher-valent vaccines may further reduce PD burden. This cost-effectiveness analysis compared PCV20 under 3+1 schedule with PCV15 and PCV13, both under 2+1 schedule, in a German pediatric population. Methods: A Markov model with annual cycles over a 10-year time horizon was adapted to simulate the clinical and economic consequences to the German population and compare pediatric vaccination with PCV20 to lower-valent PCVs. The model used PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies for vaccine direct and indirect effect estimates. Epidemiologic, utility, and medical cost inputs were obtained from published sources. Benefits and costs were discounted at 3% from a German societal perspective. Outcomes included PD cases, deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results: In the base case, PCV20 provided greater health benefits than PCV13, averting more cases of invasive pneumococcal disease (IPD; 15,301), hospitalized and non-hospitalized pneumonia (460,197 and 472,365, respectively), otitis media (531,634), and 59,265 deaths over 10 years. This resulted in 904,854 additional QALYs and a total cost-saving of €2,393,263,611, making PCV20 a dominant strategy compared with PCV13. Compared to PCV15, PCV20 was estimated to avert an additional 11,334 IPD, 704,948 pneumonia, and 441,643 otitis media cases, as well as 41,596 deaths. PCV20 was associated with a higher QALY gain and lower cost (i.e., dominance) compared with PCV15. The robustness of the results was confirmed through scenario analyses as well as deterministic and probabilistic sensitivity analyses. Conclusion: PCV20 3+1 dominated both PCV13 2+1 and PCV15 2+1 over the model time horizon. Replacing lower-valent PCVs with PCV20 would result in greater clinical and economic benefits, given PCV20 broader serotype coverage.

Felicitas Kuhne, Maren Laurenz, Christof von Eiff, and Johnna Perdrizet are employees of Pfizer. Sophie Warren was employed by Pfizer at the time of the manuscript development. An Ta is an employee of Cytel, which received funding from Pfizer in connection with the development of this manuscript.

This study was funded by Pfizer Inc.

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