Systematic review of pneumococcal disease costs and productivity loss studies in Latin America and the Caribbean

Background Pneumococcal disease is an important cause of morbidity and mortality associated with significant economic burden for healthcare systems and society. Objectives To systematically review pneumococcal disease cost of illness and productivity loss studies in the Latin America and Caribbean (LAC) region. Methods A search of relevant databases was performed till November 2011. A broad and sensitive search strategy was used consisting of medical subject headings (MeSH) terms for pneumococcal disease, healthcare costs and productivity loss studies. No language restriction was applied. Only papers from LAC region and child population were analyzed. Additional exclusion criteria included duplicate studies, and insufficient information about methods. Results A total of 1241 citations were retrieved. After applying the exclusion criteria, only 16 studies remained for analysis. There were 4 papers from Brazil, 3 from Argentina, 2 from Colombia, 2 from Mexico, 1 from Uruguay, 1 from Chile, and 3 analyzing a group of LAC countries. Only 4 were cost-of-illness studies, 11 were cost-effectiveness studies of pneumococcal vaccine and 1 study of the pneumococcal burden of disease. Methods used for quantifying health resource utilization and costing methods varied significantly among studies, as well as data sources considered. Productivity losses were considered in 8 studies, all of which used the human capital approach method. Pneumococcal disease cost estimates varied significantly depending on the pneumococcal syndromes considered, methods used, study perspective and type of costs included. Conclusion This systematic review reinforced the importance of standardization of methods for cost studies that can allow comparison and reproducibility in other settings. These estimates can be useful for future economic analysis conducted to support the decision making process on the introduction of new vaccines in LAC. However, caution must be taken, as methodological aspects of studies will result in estimates with varying levels of accuracy and external validity.