Cost-effectiveness of adult vaccinations: A systematic review

Abstract

Background: Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize economic evidence for adult vaccinations included on the adult immunization schedule. Methods: We searched PubMed, EMBASE, EconLit, and Cochrane Library from 1980 to 2016 and identified economic evaluation or cost-effectiveness analysis for vaccinations targeting persons aged ≥18 years in the U.S. or Canada. After excluding records based on title and abstract reviews, the remaining publications had a full-text review from two independent reviewers, who extracted economic values that compared vaccination to “no vaccination” scenarios. Results: The systematic searches yielded 1688 publications. After removing duplicates, off-topic publications, and publications without a “no vaccination” comparison, 78 publications were included in the final analysis (influenza = 25, pneumococcal = 18, human papillomavirus = 9, herpes zoster = 7, tetanus-diphtheria-pertussis = 9, hepatitis B = 9, and multiple vaccines = 1). Among outcomes assessing age-based vaccinations, the percent indicating cost-savings was 56% for influenza, 31% for pneumococcal, and 23% for tetanus-diphtheria-pertussis vaccinations. Among age-based vaccination outcomes reporting $/QALY, the percent of outcomes indicating a cost per QALY of ≤$100,000 was 100% for influenza, 100% for pneumococcal, 69% for human papillomavirus, 71% for herpes zoster, and 50% for tetanus-diphtheria-pertussis vaccinations. Conclusions: The majority of published studies report favorable cost-effectiveness profiles for adult vaccinations, which supports efforts to improve the implementation of adult vaccination recommendations.

Immunization: vital progress, unfinished agenda

“…Despite national recommendations 43,44 , vaccine coverage among adults in high-income countries is uneven 45 (vaccine coverage for herpes zoster, which causes shingles, among adults aged 60 or over in the United States was 24% compared with 65% for influenza among those aged 65 or over), and very low or not even available in most low-and middle-income countries 46 . Yet, several studies have shown good cost-effectiveness of adult vaccinations against influenza, pneumococcal infection, shingles, HPV and tetanus-diphtheria-pertussis 47 .…”

Host Single Nucleotide Polymorphisms Modulating Influenza A Virus Disease in Humans

“…Notably, the efficacy of vaccines against IAV infections can fluctuate and there is a significant immune response variability across the population. Factors such as previous exposure to IAV infections or vaccines, age, and the closeness of the match between the vaccine and circulating strains are important to explain differences in vaccine effectiveness between seasons and group populations [44,46,[150][151][152]. However, multiple reports have demonstrated that the host genetic background and polymorphisms on key immune response genes modulate the immune response to infection or vaccination [153][154][155][156][157][158][159][160].…”

Influenza in the school-aged population in Mexico: burden of disease and cost-effectiveness of vaccination in children

“…For influenza, the implementation of immunisation campaigns throughout the world have resulted in decreases of both mortality and morbidity [7,8]. Although usually focused on younger populations for epidemiological and practical reasons, vaccination in most age groups, including adults, is considered highly cost-effective [9,10].…”