Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine

Abstract

Context The cost-effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) compared with 23-valent pneumococcal polysaccharide vaccine (PPSV23) among US adults is unclear. Objective To estimate the cost-effectiveness of PCV13 vaccination strategies in adults to assist vaccination policy decision-making. Design, Setting, and Population A Markov state-transition model, lifetime time horizon, societal perspective. Simulations were performed in hypothetical cohorts of US 50-year-olds. Vaccination strategies and effectiveness estimates were developed by a Delphi expert panel; indirect (herd immunity) effects resulting from childhood PCV13 vaccination were extrapolated based on observed PCV7 effects. Data sources for model parameters included CDC Active Bacterial Core surveillance, National Hospital Discharge Survey and Nationwide Inpatient Sample data, and the National Health Interview Survey. Main Outcome Measures Pneumococcal disease cases prevented and incremental costs per quality-adjusted life year (QALY) gained. Results In the base case scenario, PCV13 given as a substitute for PPSV23 in current recommendations (i.e., vaccination at 65 years and at younger ages if comorbidities are present) cost $28,900/QALY gained compared with no vaccination and was more cost-effective than the currently recommended PPSV23 strategy. Routine PCV13 at ages 50 and 65 years cost $45,100/QALY compared with PCV13 substituted in current recommendations. Adding PPSV23 at age 75 to PCV13 at ages 50 and 65 years gained 0.00002 QALYs, costing $496,000/QALY gained. Results were robust in sensitivity analyses and alternative scenarios, except when low PCV13 effectiveness against nonbacteremic pneumococcal pneumonia was assumed or when greater childhood vaccination indirect effects were modeled. In these cases, PPSV23 as currently recommended was favored. Conclusions Overall, PCV13 vaccination was favored compared to PPSV23, but the analysis is sensitive to assumptions about PCV13 effectiveness against NPP and the magnitude of potential indirect effects from childhood PCV13 on pneumococcal serotype distribution.

A review of economic evaluations of 13-valent pneumococcal conjugate vaccine (PCV13) in adults and the elderly

“…[24][25][26][27][28] two were conducted for Italy 29,30 and the remaining 3 were performed for England, the Netherlands and Spain respectively. [31][32][33] Of the 5 US publications, 3 were authored by Smith et al 24,26,27 with 2 others by Weycker et al and…”

“…39 In terms of the type of economic evaluation, 7 publications were cost-utility analyses, presenting cost per Quality Adjusted Life Year (QALY) gained as the primary outcome. 24,[26][27][28][29]31,32 Whereas the studies by Liguori et al 30 and Pradas et al 33 could be classified as cost-effectiveness analyses, calculating the cost per case of pneumococcal disease avoided as the main outcome. …”

“…For invasive forms of disease, Smith et al, 24,26,27 Rozenbaum et al (England) 31 and Cho et al 28 categorized IPD into meningitis and other IPD. Boccalini et al 29 and Weycker et al 25 used similar approaches but used bactaeremic pneumococcal pneumonia and bacteremia respectively instead of all other IPD.…”

Review: Current and new generation pneumococcal vaccines

“…25,52 Modelling studies of PCV13 in older adults, including immunocompromised adults, have suggested that a single dose of PCV13 may be more practical economically than previous vaccine recommendations. 25,53,54 In addition, a microsimulation model in which it was assumed that PCV13 efficacy in adults would be comparable to PCV7 in children, together with reasonable assumptions regarding risks and costs of IPD and non-bacteraemic pneumonia, projected that routine PCV13 in place of PPV23 would result in a greater reduction in burden of pneumococcal disease in US adults.…”

Pneumococcal conjugate vaccines for adults

“…The CAPiTA results will help to improve the accuracy of currently-available models. 12 The CAPiTA trial excluded some individuals who are at a particularly high risk of disease (those with immunodeficiencies and nursing home residents). In addition, results of how age affected efficacy have not yet been reported.…”