Impact of Pneumococcal Vaccination on Pneumonia Hospitalizations and Related Costs in Ontario: A Population-Based Ecological Study

Luca, Dara Lee; Kwong, Jeffrey C.; Chu, Anna; Sander, Beate; O’Reilly, Ryan; McGeer, Allison; Bloom, David E.

doi:10.1093/cid/cix850

Cited by 28 publications

(27 citation statements)

References 21 publications

(29 reference statements)

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“…Reductions in AC‐CAP hospitalizations of 36%, 20% and 16% in children <2, 2–4 and 5–17 years of age, respectively, and even more pronounced decreases in PL‐CAP, are consistent with reports from most other countries . These findings are concordant with previous publications from Sweden that reported up to 37% reduction of inpatient all‐cause pneumonia in children < 2 years in 2012 .…”

Section: Discussionsupporting

confidence: 92%

“…Reports on the indirect effect of PCV‐CIP on CAP in the elderly have been inconsistent. The first reports on reduced incidence of AC‐CAP hospitalizations came from the United States, and thereafter from Canada and Finland . However, in a recent study that adjusted for secular trends using the synthetic control method, there was no observed reduction of hospitalization for all‐cause pneumonia after PCV‐CIP introduction in any of five countries in the Americas (the United States, Mexico, Ecuador, Brazil and Chile) .…”

Section: Discussionmentioning

confidence: 99%

“…Yet, the conjugate vaccines only cover 7-13 pneumococcal serotypes and due to expansion of nonvaccine serotypes, the overall impact on IPD in adults has been small in many settings, especially in older persons [5,8]. The impact of PCV childhood immunization programmes (PCV-CIP) on CAP among children show a reduced burden of disease for both all-cause pneumonia and pneumonia with more pneumococcal-specific diagnoses, but there are discrepant results concerning the impact among the elderly [9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

et al. 2019

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Background There is limited evidence on the impact of pneumococcal conjugate vaccine childhood immunization programmes (PCV‐CIP) on community‐acquired pneumonia (CAP) in individuals with underlying diseases. Methods A nationwide cohort study using Swedish health registers to assess the incidence of hospitalization with all‐cause (AC‐CAP) and pneumococcal or lobar (PL‐CAP) CAP between 2005 and 2015, in relation to PCV‐CIP introduction in 2007–09. Results In total, 303 691 episodes of AC‐CAP occurred, of which 14 225 were PL‐CAP. Comparing before (2005–06) with after (2014–15) PCV‐CIP, relative incidence reductions were 36% (95% Confidence Interval 32–40), 20% (14–25) and 16% (11–22) of AC‐CAP for age groups < 2, 2–4 and 5–17 years, respectively, with similar reductions in young children with and without comorbidities. The reductions were more pronounced for PL‐CAP. In the age groups 40–64, 65–74, 75–84 and ≥85 years there were relative increases of 11% (8–14), 18% (15–22), 15% (12–17) and 30% (27–34) of AC‐CAP, respectively, but these increases were attenuated after adjustment for admittance practices using four control conditions. In adults with comorbidities, there was an increase in incidence of AC‐CAP, and PL‐CAP, in contrast to adults without reported underlying diseases where the incidence was stable or diminished for some age groups. Over the study period, there was an increased proportion of pneumonia patients with underlying diseases in all ages. Conclusion This emphasizes that direct preventive interventions should be targeted towards individuals with underlying diseases. Future studies should investigate reasons for the observed increased risk in adults with comorbidities, for example due to pneumococcal nonvaccine serotypes, or other pathogens, preferentially affecting subjects with underlying diseases.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

et al. 2019

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“…The estimated net savings may be underestimated, as our assumptions were generally conservative. For example, Luca and colleagues found that incidence of pneumonia hospitalizations and costs have declined by 35-45% in the PCV era compared with pre-PCV-era data [5]. Our findings suggested a 10% reduction in pneumococcal pneumonia, substantially lower than that reported in the Luca study.…”

Section: Discussioncontrasting

confidence: 62%

“…Since their inclusion in routine IIPs, PCVs have substantially reduced the incidence of IPD, pneumonia, and AOM in Canada, which translated into a reduction in health care resource use [3][4][5][6][7]. Public health budgets are constrained in Canada, with limited funds available for the introduction of new vaccine programs.…”

Section: Introductionmentioning

confidence: 99%

Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis

et al. 2020

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Objective: A model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively. Methods: Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use. Results: PCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM. Conclusions: Canadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs.

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The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

et al. 2021

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Background To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. Methods Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias. Results Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out. Conclusion Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.

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Impact of Pneumococcal Vaccination on Pneumonia Hospitalizations and Related Costs in Ontario: A Population-Based Ecological Study

Cited by 28 publications

References 21 publications

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis

The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

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