Public Health and Economic Impact of transitioning to a 20-valent pneumococcal vaccine in Kazakhstan’s Pediatric National Immunization Program

Public Health and Economic Impact of transitioning to a 20-valent pneumococcal vaccine in Kazakhstan’s Pediatric National Immunization Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Public Health and Economic Impact of transitioning to a 20-valent pneumococcal vaccine in Kazakhstan’s Pediatric National Immunization Program Thea Paoula Nassar, Kamila Tuyakbayeva, Aigerim Shaimagambetova, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8630544/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background/Objectives: Kazakhstan has implemented the 13-valent pneumococcal conjugate vaccine (PCV13) with a 2 + 1 dosing schedule in its pediatric National Immunization Program (NIP) since 2010. A 10-valent PCV (PCV10-SII) is registered and licensed in a 3 + 0 dosing schedule. Despite these efforts, the burden of pneumococcal disease (PD) persists. Recently, a 20-valent PCV (PCV20) was approved for infants aged six weeks and older in a 2 + 1 or 3 + 1 schedule. This study assesses the cost-effectiveness of switching to PCV20, and the impact of delaying its introduction in Kazakhstan’s NIP. Methods A decision-analytic Markov model estimated the cost-effectiveness of PCV20 versus PCV13 and PCV10-SII from a payer perspective. Costs and outcomes were discounted at 5.0% annually. Vaccine effectiveness of PCV20 was based on PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies. Epidemiologic and cost inputs were shared with Pfizer or sourced from publications relevant to Kazakhstan. Sensitivity and scenario analyses were conducted to assess the impact of variations in input parameters on the robustness of the results. Results Compared to PCV13 (2 + 1) and PCV10-SII (3 + 0), implementing PCV20 with either a 2 + 1 or 3 + 1 schedule is projected to avert a substantial burden of PD cases and deaths over 10 years, resulting in greater direct medical cost saving. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV10-SII. Results remained robust from sensitivity analyses and scenario assessments. Delaying PCV20 implementation in Kazakhstan’s pediatric NIP by 2 years would result in negative public health and economic outcomes. Conclusions Implementing PCV20 in Kazakhstan’s NIP could substantially reduce PD burden and associated healthcare costs, delivering greater public health and economic impact. pneumococcal disease cost-effectiveness pneumococcal conjugate vaccination pediatric PCV20 PCV13 PCV10-SII Kazakhstan Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialsKazakhstan.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 02 Feb, 2026 Editor assigned by journal 20 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 18 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8630544","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584880385,"identity":"4fe58e54-f2df-4e7b-950b-35ae3e0704bd","order_by":0,"name":"Thea Paoula Nassar","email":"","orcid":"","institution":"Pfizer Ltd","correspondingAuthor":false,"prefix":"","firstName":"Thea","middleName":"Paoula","lastName":"Nassar","suffix":""},{"id":584880386,"identity":"50a7c905-abfa-47b1-83ed-f70752dbe8c9","order_by":1,"name":"Kamila 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Allocation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pneumococcal disease; cost-effectiveness; pneumococcal conjugate vaccination; pediatric, PCV20, PCV13, PCV10-SII, Kazakhstan","lastPublishedDoi":"10.21203/rs.3.rs-8630544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8630544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground/Objectives:\u003c/h2\u003e \u003cp\u003eKazakhstan has implemented the 13-valent pneumococcal conjugate vaccine (PCV13) with a 2\u0026thinsp;+\u0026thinsp;1 dosing schedule in its pediatric National Immunization Program (NIP) since 2010. A 10-valent PCV (PCV10-SII) is registered and licensed in a 3\u0026thinsp;+\u0026thinsp;0 dosing schedule. Despite these efforts, the burden of pneumococcal disease (PD) persists. Recently, a 20-valent PCV (PCV20) was approved for infants aged six weeks and older in a 2\u0026thinsp;+\u0026thinsp;1 or 3\u0026thinsp;+\u0026thinsp;1 schedule. This study assesses the cost-effectiveness of switching to PCV20, and the impact of delaying its introduction in Kazakhstan\u0026rsquo;s NIP.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA decision-analytic Markov model estimated the cost-effectiveness of PCV20 versus PCV13 and PCV10-SII from a payer perspective. Costs and outcomes were discounted at 5.0% annually. Vaccine effectiveness of PCV20 was based on PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies. Epidemiologic and cost inputs were shared with Pfizer or sourced from publications relevant to Kazakhstan. Sensitivity and scenario analyses were conducted to assess the impact of variations in input parameters on the robustness of the results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCompared to PCV13 (2\u0026thinsp;+\u0026thinsp;1) and PCV10-SII (3\u0026thinsp;+\u0026thinsp;0), implementing PCV20 with either a 2\u0026thinsp;+\u0026thinsp;1 or 3\u0026thinsp;+\u0026thinsp;1 schedule is projected to avert a substantial burden of PD cases and deaths over 10 years, resulting in greater direct medical cost saving. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV10-SII. Results remained robust from sensitivity analyses and scenario assessments. Delaying PCV20 implementation in Kazakhstan\u0026rsquo;s pediatric NIP by 2 years would result in negative public health and economic outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eImplementing PCV20 in Kazakhstan\u0026rsquo;s NIP could substantially reduce PD burden and associated healthcare costs, delivering greater public health and economic impact.\u003c/p\u003e","manuscriptTitle":"Public Health and Economic Impact of transitioning to a 20-valent pneumococcal vaccine in Kazakhstan’s Pediatric National Immunization Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 12:35:26","doi":"10.21203/rs.3.rs-8630544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T15:44:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286693515228390216677980627029715366303","date":"2026-05-04T10:47:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1856563409558997207885124456174897082","date":"2026-04-29T08:14:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T13:51:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47431584466561714443592579497600995766","date":"2026-04-28T10:32:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T22:16:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-20T08:45:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T08:45:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cost Effectiveness and Resource Allocation","date":"2026-01-18T10:00:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cost-effectiveness-and-resource-allocation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cera","sideBox":"Learn more about [Cost Effectiveness and Resource Allocation](http://resource-allocation.biomedcentral.com)","snPcode":"12962","submissionUrl":"https://submission.nature.com/new-submission/12962/3","title":"Cost Effectiveness and Resource Allocation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3ae9eea7-07b9-41a6-8d6b-591522a8bdb2","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T15:44:45+00:00","index":125,"fulltext":""},{"type":"reviewerAgreed","content":"286693515228390216677980627029715366303","date":"2026-05-04T10:47:22+00:00","index":124,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T12:35:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 12:35:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8630544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8630544","identity":"rs-8630544","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}