Cost-effectiveness of pneumococcal vaccination strategies for the elderly in Korea

Abstract

BackgroundAlthough the 13-valent pneumococcal conjugate vaccine (PCV13) showed good efficacy against pneumococcal disease in the the CAPiTA trial, the 23-valent pneumococcal polysaccharide vaccination (PPSV23) program has been ongoing for older adults aged ≥ 65 years in Korea since May of 2013. This study aimed to evaluate the cost-effectiveness of the current vaccination strategy (a single-dose PPSV23 vaccination) compared to a single-dose PCV13 vaccination and sequential PCV13-PPSV23 vaccinations in the elderly population aged ≥ 65 years.MethodsUsing a Markov model, the incremental cost-effectiveness ratios (ICERs) of three vaccination strategies were assessed in a societal context. The transition probabilities, utility weights to estimate quality adjusted life year (QALY), and disease treatment costs were either calculated or cited from published data and the Health Insurance Review and Assessment Service. Simulations were performed in hypothetical cohorts of Korean adults aged ≥ 19 years. The vaccine effectiveness of PPSV23 was cited from a Cochrane Review report, while PCV13 effectiveness data were gathered from the CAPiTA trial.ResultsCurrent PPSV23 vaccination strategies were cost-effective (ICER, $25,786 per QALY). However, the administration of PCV13 as a substitute for PPSV23 was shown to be more cost-effective than PPSV23 vaccination (ICER, $797 per QALY). Sequential PCV13-PPSV23 vaccination was also more cost-effective than PPSV23 for elderly people aged ≥ 65 years. In sensitivity analysis assuming significant PPSV23 effectiveness (50%) against non-bacteremic pneumococcal pneumonia, the PCV13 vaccination strategy was superior to the PPSV23 vaccination strategy in terms of cost-effectiveness.ConclusionThe results suggest that PCV13 vaccination is more cost-effective in elderly subjects aged ≥ 65 years compared to the current PPSV23 vaccination strategy. When complete data is obtained in 2018 on the maximal herd effects of childhood PCV13 immunization, the incidence of pneumococcal pneumonia and the cost-effectiveness of vaccination strategies need to be reassessed.

Disease burden of hospitalized community-acquired pneumonia in South Korea

“…Considering significantly high disease burden in the elderly, Korean government have subsidized influenza and pneumococcal vaccines for the old adults aged ≥65 years since 1997 and 2013 years, respectively. [ 13 , 14 ] As for the pneumococcal national immunization program (NIP), free 23-valent pneumococcal polysaccharide vaccine (PPV23) vaccine has been provided for all people aged ≥65 years with a target coverage of 60%. [ 13 ] As of 2016, the coverage rates of influenza vaccine and PPV23 were estimated to be about 80% and 60%, respectively.…”

“…[ 13 , 14 ] As for the pneumococcal national immunization program (NIP), free 23-valent pneumococcal polysaccharide vaccine (PPV23) vaccine has been provided for all people aged ≥65 years with a target coverage of 60%. [ 13 ] As of 2016, the coverage rates of influenza vaccine and PPV23 were estimated to be about 80% and 60%, respectively. [ 13 , 15 ]…”

“…[ 13 ] As of 2016, the coverage rates of influenza vaccine and PPV23 were estimated to be about 80% and 60%, respectively. [ 13 , 15 ]…”

The cost-effectiveness of using pneumococcal conjugate vaccine (PCV13) versus pneumococcal polysaccharide vaccine (PPSV23), in South African adults

“…), comparator (PPSV23 or no vaccine), seroepidemiology and treatment cost. For example, four studies found vaccination with PCV13 to be cost-effective compared to vaccination with PPSV23 [61,70,72,73], and two studies found vaccination with PCV13 to be cost-effective compared to no vaccination [20,72]. In contrast to this, three studies found vaccination with PCV13 in sequence with vaccination with PPSV23 to not be cost-effective compared to PPSV23 alone [69,74,75].…”

“…Mangen et al, however, compared a single dose of PCV13 to no vaccination and results imply that, in that scenario, PCV13 is cost-effective [20]. Other studies in many other countries show similar results, although the vaccination strategies are diverse [69][70][71][72]. It must be noted that these studies are diverse in the population to be vaccinated, vaccination strategies used (sequential use of PCV13->PPSV23, PCV13, revaccination, etc.…”