Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs.

Over the past century, tropical medicine has passed through several overlapping phases. Initially, the picture was of endemic and epidemic diseases that wreaked havoc on people living in warm climates and visitors to these areas. High morbidity and mortality associated with these diseases reflected the poor state of knowledge about their causes and epidemiology and the lack of effective technologies for their control. At this stage, tropical medicine was dominated by parasitic and infectious diseases that had affinity for warm climates and some specific nutritional disorders. The next phase involved the steady accumulation of knowledge about the aetiological agents and, in the case of parasitic and infectious diseases, identification of reservoirs and vectors. The development of new and improved technologies for the control of tropical diseases characterised the third phase. The new products included drugs, diagnostic tools, vector control measures and vaccines. In the fourth phase, the new technologies are being deployed in programmes aimed at achieving disease control and, where feasible, total elimination of the problem. In the course of these operations, many useful lessons have been learnt from both the successes and failures of major schemes. In particular, experience has shown the important role of research not only in providing new technologies but also in optimising their effectiveness when applied in control programmes. The role of social and behavioural factors in the epidemiology and control of tropical diseases has drawn attention to the value of a multidisciplinary approach in designing and implementing control programmes. There is a sense of cautious optimism that, if the lessons learnt over the past century are carefully applied, further gains can be made in controlling and eliminating the classical problems that characterised tropical medicine at the beginning of this century.

Background: In the United States (US), congenital cytomegalovirus infection (cCMVi) is a major cause of permanent disabilities and the most common etiology of non-genetic sensorineural hearing loss. Evaluations of prevention strategies will require estimates of the economic implications of cCMVi. We aimed to develop a conceptual framework to characterize the lifetime economic burden of cCMVi in the US and to use that framework to identify data gaps.Methods: Direct health care, direct non-health care, indirect, and intangible costs associated with cCMVi were considered. An initial framework was constructed based on a targeted literature review, then validated and refined after consultation with experts. Published costs were identified and used to populate the framework. Data gaps were identified.Results: The framework was constructed as a chance tree, categorizing clinical event occurrence to form patient profiles associated with distinct economic trajectories. The distribution and magnitude of costs varied by patient life stage, cCMVi diagnosis, severity of impairment, and developmental delays/disabilities. Published studies could not fully populate the framework. The literature best characterized direct health care costs associated with the birth period. Gaps existed for direct non-health care, indirect, and intangible costs, as well as health care costs associated with adult patients and those severely impaired.Conclusions: Data gaps exist concerning the lifetime economic burden of cCMVi in the US. The conceptual framework provides the basis for a research agenda to address these gaps. Understanding the full lifetime economic burden of cCMVi would inform clinicians, researchers, and policymakers, when assessing the value of cCMVi interventions.