Cost-effectiveness analysis of 13-valent pneumococcal conjugate vaccine versus 23-valent pneumococcal polysaccharide vaccine in an adult population in South Korea

Abstract

In South Korea, the National Immunization Program offers a 23-valent pneumococcal polysaccharide vaccine (PPSV23) for the elderly; however, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included, and vaccination is not offered to younger, at-risk populations. This study offers a comparative analysis of PCV13 and PPSV23 in Korea's adults, stratified by age and risk group. A Markov model with a lifetime horizon was developed from the healthcare perspective. Data sources included the Health Insurance Review & Assessment Service, Korea Centre for Disease Control & Prevention and Korean medical institutions. An expert panel tested data validity. The CAPiTA trial and Cochrane meta-analysis were used to obtain vaccine effectiveness data. Regardless of co-morbidity, when the sequential PCV13-PPSV23 strategy was compared to that using PPSV23-only, in elderly populations, the incremental cost-effectiveness ratio (ICER) was 3,300 USD per quality-adjusted life years (QALY). For the risk group aged ≥65 years, the ICER of the addition of PCV13 over the existing PPSV23-only strategy was 3,404 USD/QALY. However, on replacing PPSV23 with PCV13, for all elderly populations, an ICER of 1,421 USD/QALY resulted; for the risk group aged ≥65 years, the ICER was 1,736 USD/QALY. For the 18-64 year-old risk group, the sequential PCV13-PPSV23 strategy yielded an ICER of 3,629 USD/QALY over the PPSV23-only strategy, and 6,643 USD/QALY compared to no vaccination. Thus, the PCV13→PPSV23 combination strategy for elderly populations was found to be a cost-effective alternative to the current National Immunization Program regardless of co-morbidity. This finding was the same as that for younger, at-risk populations.

The Practice Guideline for Vaccinating Korean Patients with Autoimmune Inflammatory Rheumatic Disease

“…PCV13 shows good immunogenicity and also proved to be effective in preventing pneumonia in healthy adults. The finding that it is cost-effective to give both vaccines to high-risk patients of pneumococcal infection is true; therefore it is safe to administer both the PCV13 and the PPSV23 to adult patients with AIIRD [ 89 ]. A booster effect is caused when administering the PCV13 first, while a hypo-responsiveness is caused when administering the PPSV23 first; therefore, it is advisable to administer the PCV13 first [ 90 ].…”

Cost-Effectiveness Analysis of 23-Valent Pneumococcal Polysaccharide Vaccine Program for the Elderly Aged 60 Years or Older in Shanghai, China

“…The purpose of this study was to evaluate the economics of a major public health program in Shanghai that has vaccinated PPSV-23 for people 60 years or older for free since 2013. This study took the vaccinated population in the project as the target population, which was different from general economic evaluation research that was to simulate a group of people of the same age and the parameters change with the change of age ( 15 , 19 , 20 ). The study population was divided into eight different groups by age and risk.…”

“…Parameters for the epidemiological data were obtained from the published literature and through the expert consultation of nine epidemiologists, clinicians, and SCDC experts (15,(19)(20)(21).…”

Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults

“…We are concerned whether the pneumococcal immunization program is introduced based on the cost-effectiveness studies evaluated by QALY and ICER. There are several studies published for the cost-effectiveness of pneumococcal vaccine by QALY and ICER in different countries [21,99,100]. However, the results differ in each area and country.…”