Cost-Effectiveness of Pneumococcal Vaccines for Adults in the United States

Abstract

IntroductionIn 2012, the Advisory Committee on Immunization Practices (ACIP) revised recommendations for adult pneumococcal vaccination to include a sequential regimen of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for certain high-risk adults with immunocompromising conditions. This study, from a payer perspective, examined: (1) the cost-effectiveness of the new 2012 ACIP vaccine policy recommendation relative to the 1997 ACIP recommendation; (2) the cost-effectiveness of potential future pneumococcal vaccination policies; and (3) key assumptions that influence study results.MethodsA static cohort model that incorporated costs, health outcomes, and quality-adjusted life-year (QALY) losses associated with invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia (NBPP) was developed to evaluate seven pneumococcal vaccination strategies for a 50-year-old adult cohort over a 50-year period using incremental cost-effectiveness ratios (ICERs).ResultsFor objective 1, the 2012 ACIP recommendation is the more economically efficient strategy (ICER was $25,841 per QALY gained vs. no vaccination). For objective 2, the most efficient vaccination policy would be to maintain the 2012 recommendation for PPSV23 for healthy and immunocompetent adults with comorbidities, and to modify the recommendation for adults with immunocompromising conditions by replacing PPSV23 with a sequential regimen of PCV13 and PPSV23 at age 65 (ICER was $23,416 per QALY gained vs. no vaccination). For objective 3, cost-effectiveness ratios for alternative pneumococcal vaccine policies were highly influenced by assumptions used for vaccine effectiveness against NBPP and accounting for the herd protection effects of pediatric PCV13 vaccination on adult pneumococcal disease.ConclusionModifying the 2012 recommendation to include an additional dose of PCV13 at age 65, followed by PPSV23, for adults with immunocompromising conditions appears to be a cost-effective vaccine policy. Given the uncertainty in the available data and the absence of key influential data, comprehensive sensitivity analyses should be conducted by policy-makers when evaluating new adult pneumococcal vaccine strategies.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0115-y) contains supplementary material, which is available to authorized users.

13-Valent Pneumococcal Conjugate Vaccine: A Review of Its Use in Adults

“…Several fully published, modelled pharmacoeconomic analyses of PCV13 in adults have been conducted in various European countries [46][47][48][49][50][51] and in the USA [52][53][54][55][56][57] ( Table 2). All of the analyses incorporated data from a number of different sources, such as published clinical trials and expert opinion, although none were recent enough to include data from CAPiTA.…”

“…All of the analyses incorporated data from a number of different sources, such as published clinical trials and expert opinion, although none were recent enough to include data from CAPiTA. Most were costeffectiveness analyses (CEAs) comparing various pneumococcal vaccination strategies in specific adult populations, with results expressed in terms of an incremental cost-effectiveness ratio (ICER) [47,[50][51][52][53][54][55][56]. ICERs were reported in terms of the incremental cost per quality-adjusted life-year (QALY) gained, and results were considered cost effective if ICER values were below commonly used cost-effectiveness thresholds (e.g.…”

“…Results of sensitivity analyses of the CEAs generally showed that base-case results were robust to reasonable changes in most parameter values, although in some analyses results were highly sensitive to changes in PCV13 cost [47,50,51,54], predicted herd effects of childhood vaccination [50,52,55], vaccine effectiveness [50][51][52][53][54][55][56], parameters related to inpatient CAP [47,51] and life expectancy [56].…”

Vaccination against Pneumococcal Infections of High-Risk People: Pharmacoeconomic Aspects

“…В базовом варианте анализ проводили для режима вакцинации, предполагающего введение 1 дозы ПКВ13 и 1 дозы ППВ23 через 8 недель с ревакцинацией ППВ23 через 5 лет [3][4][5]. Заболеваемость пневмококковыми инфекциями рассчитывалась с учетом общего показателя заболеваемости в российской популяции граждан старше 18 лет [6] и численности различных возрастных групп, а также соотношения заболеваемости в различных возрастных группах, выявленного в зарубежных исследованиях [3]. При этом учитывали, что доля пневмококковой пневмонии у взрослых в РФ составляет 76% от общего количества случаев заболевания внебольничной пневмонией.…”

Revisão sistemática de estudos de avaliação econômica da vacinação universal em adultos acima de 60 anos de idade com a vacina pneumocócica polissacarídea 23-valente

“…dois estudos eram análises econômicas parciais [159,160]; três estudos apenas descreveram dados de outros estudos econômicos [115,161,162]; quatro estudos avaliaram a vacina pneumocócica em adultos ou incluíram na análise uma população mista de adultos e idosos [163][164][165][166]; e 10 publicações eram revisões sistemáticas sobre o tema [113,114,116,146,[167][168][169][170][171][172]].…”