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

Abstract

The 13-valent pneumococcal conjugated vaccine (PCV13) is already recommended for some adult groups and is being considered for wider use in many countries. In order to identify the strengths and limitations of the existing economic evaluation studies of PCV13 in adults and the elderly a literature review was conducted. The majority of the studies identified (9 out of 10) found that PCV13 was costeffective in adults and/or the elderly. However, these results were based on assumptions that could not always be informed by robust evidence. Key uncertainties included the efficacy of PCV13 against non-invasive pneumonia and the herd immunity effect of childhood vaccination programs. Emerging trial evidence on PCV13 in adults from the Netherlands offers the ability to parameterize future economic evaluations with empirical efficacy data. However, it is important that these estimates are used thoughtfully when they are transferred to other settings.

Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

“…4 Recent evidence has shown that PCV13 is efficacious against vaccine-type community acquired pneumonia, 5 which remains prevalent among older adults despite recently observed declines due to herd protection provided by use of PCV7 and PCV13 among children. 3,6 While previous studies have examined the cost-effectiveness of vaccinating old adults with PCV13, 7 this study fills a gap in the literature by incorporating clinical trial evidence of PCV13 effectiveness against community acquired pneumonia. We aimed to evaluate the marginal cost-effectiveness of the new recommendation as well as three alternate strategies to add PCV13 to the immunization schedule for adults.…”

What do we know about the cost-effectiveness of pneumococcal conjugate vaccination in older adults?

“…The efficacy assumed for PCV13 against vaccine-type non-bacteremic pneumococcal pneumonia in these analyses tended to be higher than subsequently found in the CAPiTA trial. 21 Likewise, the proportion of all pneumonia assumed to be caused by pneumococcus was often relatively high (30%-40%) 21 when compared to some recent data. 35 To reliably inform vaccine policy, new economic evaluations are required that use the best data now available, particularly the CAPiTA trial data and up-to-date data on the evolving serotype-specific disease burden in each setting.…”

“…The lack of reliable data on this outcome for PPV23 is unfortunate, as the relative efficacy assumed for each vaccine against non-invasive pneumonia (particularly cases resulting in death) is very influential when estimating their cost-effectiveness. 21 The duration of vaccine-induced protection is likely to be equally important in estimating the cost and benefits of alternative pneumococcal vaccines. Most economic evaluations have evaluated the use of the vaccines in older adults of various ages under 75 years, 21 as the very old are more likely to have reduced immunogenicity to vaccination.…”

“…21 The duration of vaccine-induced protection is likely to be equally important in estimating the cost and benefits of alternative pneumococcal vaccines. Most economic evaluations have evaluated the use of the vaccines in older adults of various ages under 75 years, 21 as the very old are more likely to have reduced immunogenicity to vaccination. However, the risk of pneumococcal disease increases with age so that the assumptions around the ongoing vaccine protection provided as vaccinated individuals age will substantially change the benefits of vaccination.…”

“…Before the publication of the CAPiTA trial, there were a number of economic evaluations that evaluated PCV13 use in older adults. 21 As a result, these evaluations had to make assumptions about the efficacy of PCV13 against both serotype-specific non-bacteremic pneumococcal pneumonia and invasive disease. The efficacy assumed for PCV13 against vaccine-type non-bacteremic pneumococcal pneumonia in these analyses tended to be higher than subsequently found in the CAPiTA trial.…”