Cost-Effectiveness Analysis of 23-Valent Pneumococcal Polysaccharide Vaccine Program for the Elderly Aged 60 Years or Older in Shanghai, China

Abstract

Background: The pneumococcal vaccine has been considered as the most effective measure to prevent pneumococcal diseases. In 2013, Shanghai launched a major public health program to vaccinate people aged 60 years or older with 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV-23) free of charge. By the end of June 2020, a total of 1.56 million old people had been vaccinated free of charge.Objective: To evaluate the cost-effectiveness of PPSV-23 vaccination program in Shanghai from the health system perspective.Methods: According to the actual number of people aged 60 years or older with PPSV-23 vaccination in Shanghai from 2013 to 2018, a multi-cohort Markov model for life-time was developed to compare health and economic outcomes of vaccinated people vs. if they were not vaccinated for PPSV-23. Cost effectiveness was reported as incremental cost effectiveness ratio (ICER). A 5% discount rate was used for both costs and health outcomes. In addition, one-way sensitivity analysis was used to test the model's robustness.Results: By the end of 2018, a total of 1,091,967 people aged 60 years or older were vaccinated with PPSV-23 in Shanghai, China. Comparing with the unvaccinated circumstances, PPSV-23 vaccination would cost US $19.62 million more and receive an additional 10,321.3 quality-adjusted life-year (QALY). PPSV-23 was associated with the ICER of $190.1 per QALY gained. The Results were sensitive to the variation of vaccine effectiveness against community-acquired pneumonia (CAP), and disease incidence, mortality, and costs of CAP. In all sensitivity analysis, the PPSV-23 was economical.Conclusion: The PPSV-23 vaccination program in Shanghai was cost-effective. With the further development of the project, the administrative costs of the vaccine will be reduced, making it more cost-effective.

A narrative review on vaccination rate and factors associated with the willingness to receive pneumococcal vaccine in Chinese adult population

“…A total of 1.56 million elderly population were vaccinated through this program with an estimated coverage of 30%. 22 …”

“…Shanghai has implemented a policy to provide free vaccine to residents with 60 years or old with PPSV-23 since 2013 which lead to increased vaccination rate (1.56 million people were vaccinated). 10 , 22 A questionnaire survey among the elderly residents (aged 50–69 years) in 13 communities in Shanghai in 2020 reported that price sensitivity plays a key role in acceptance of PPSV-23 vaccination. Vaccination willingness was 79.4% (free PPSV-23 for local persons), 54.7% (self-paid PPV23 for non-local persons).…”

“…Couple of previous studies have analyzed the cost-effectiveness of PPSV-23 vaccination program in Shanghai from the health system perspective. 22 , 52 Routine vaccination of the elderly population with PPSV-23 was found to be cost-effective. A study conducted by Zhao et al, on people aged ≥ 60 years in Shanghai, China, in 2016 reported that incremental cost-effectiveness ratio of PPSV-23 vaccination compared with no vaccination was $16,699/quality-adjusted life years gained, which was lower than the per capita GDP of Shanghai ($16,840).…”

“…Shanghai was the first city that initiated the CIP in 2013. 22 Currently, around 15 cities offer the free pneumococcal vaccination in China. In 2019, among the overall pneumococcal doses released, around 16% were covered under CIP ( Figure 2 ).…”