Intercambiabilidad entre las vacunas antineumocócicas conjugadas: revisión sistemática y meta-análisis

CIAPPONI, AGUSTÍN; LEE, A.; BARDACH, ARIEL; GLUJOVSKY, D; REY-ARES, LUCILA; CAFFERATA, MARÍA LUISA; VALANZASCA, P; GARCIA MARTÍ, SEBASTIAN

Conferencia; ISPOR 3rd Latin America Conference; 2011

Background: Streptococcus pneumoniae (pneumococcus) is a leading cause of serious illness among children worldwide. Pneumococcal conjugate vaccines that include 7, 9, 10, 11, 13, and 15 serotypes have been developed. Objectives: Assess the comparative efficacy, cost-effectiveness, immunogenicity and safety of interchangeability among Pneumococcal Conjugate Vaccines and Schemes. Methods: A systematic search was conducted in December 2010 on the main electronic literature and regional databases, generic and academic Internet search and meta-search engines, Cochrane Central Register of Controlled Trials. Databases containing regional proceedings or congresses, annals and doctoral theses were also searched. No language or temporal restriction was imposed.  We included all randomized controlled trials, economic evaluations, systematic reviews and meta-analysis evaluating antibody response, cost-effectiveness and clinical effectiveness of the interchangeability among Pneumococcal conjugated vaccines. Pairs of reviewers independently selected and assessed the quality of the studies and discrepancies were solved by consensus of the whole team. Results: 21 out of 159 studies were included. There is currently no direct data available on the interchangeability among PCV for  primary  series. Some studies demonstrated noninferiority immunogenicity between PHiD-CV and PCV7. The tolerability profile of PHiD-CV was  similar to that of PCV7, when both vaccines were coadministered with other routine pediatric vaccines. Regarding cost effectiveness profiles PhiD-CV and PCV13 were consistently more costeffective than PCV7 at a constant price. When PHiD-CV and PCV13 were compared against each other the results varied according to price, indirect effects and indirect costs. Conclusions: In general, PHiD-CV gains more QALYs due to the prevention of more frequent yet less severe events such as otitis media; and PCV13 prevents less frequent events but more costly as invasive diseases (meningitis or bacteremia). Although we found no direct evidence, the two scientific recommendations identified in the search advise that PCV13 and PHiD-CV could be interchanged with PCV7.