Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya John Ojal, PhD, Ulla Griffiths,

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Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya John Ojal, PhD, Ulla Griffiths, PhD, Laura L Hammitt, MD, Ifedayo Adetifa, PhD, Donald Akech, BSc, Collins Tabu, PhD, J Anthony G Scott, FRCP, Stefan Flasche, PhD The Lancet Global Health Volume 7, Issue 5, Pages e644-e654 (May 2019) DOI: 10.1016/S2214-109X(18)30562-X Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Model fit to carriage data Recorded (circles, with 95% credible intervals shown by vertical lines) and predicted (horizontal lines, with 95% predictive intervals shown by shaded areas) carriage prevalence of different vaccine serotypes over time. VT=vaccine serotypes. sNVT=strong non-vaccine serotypes. wNVT=weak non-vaccine serotypes. The Lancet Global Health 2019 7, e644-e654DOI: (10.1016/S2214-109X(18)30562-X) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Model fit to IPD incidence data Recorded (circles, with 95% credible intervals shown by vertical lines) and predicted (horizontal lines with 95% predictive intervals shown by shaded areas) IPD incidence of vaccine serotypes over time. IPD=invasive pneumococcal disease. VT=vaccine-serotypes. sNVT=strong non-vaccine serotypes. wNVT=weak non-vaccine serotypes. The Lancet Global Health 2019 7, e644-e654DOI: (10.1016/S2214-109X(18)30562-X) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 IPD incidence, costs, DALYs, and incremental cost-effectiveness ratio if PCV is continued or discontinued in Kenya, 2022–32 Shaded areas are 95% prediction intervals. Vertical dotted lines indicate Gavi transition stages. DALY=disability-adjusted life-year. IPD=invasive pneumococcal disease. PCV=pneumococcal conjugate vaccine. The Lancet Global Health 2019 7, e644-e654DOI: (10.1016/S2214-109X(18)30562-X) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Cost-effectiveness acceptability curve Probability of continuing pneumococcal conjugate vaccine being cost-effective against the willingness to pay per DALY averted. DALY=disability adjusted life-year. The Lancet Global Health 2019 7, e644-e654DOI: (10.1016/S2214-109X(18)30562-X) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions