Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults

Abstract

Objective Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group. Design Markov model-based cost-effectiveness analysis Methods The model considered immunocompromised persons aged 18–64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia. Results In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario. Conclusions One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.

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

“…[24][25][26][27][28] two were conducted for Italy 29,30 and the remaining 3 were performed for England, the Netherlands and Spain respectively. [31][32][33] Of the 5 US publications, 3 were authored by Smith et al 24,26,27 with 2 others by Weycker et al and…”

“…39 In terms of the type of economic evaluation, 7 publications were cost-utility analyses, presenting cost per Quality Adjusted Life Year (QALY) gained as the primary outcome. 24,[26][27][28][29]31,32 Whereas the studies by Liguori et al 30 and Pradas et al 33 could be classified as cost-effectiveness analyses, calculating the cost per case of pneumococcal disease avoided as the main outcome. …”

“…For invasive forms of disease, Smith et al, 24,26,27 Rozenbaum et al (England) 31 and Cho et al 28 categorized IPD into meningitis and other IPD. Boccalini et al 29 and Weycker et al 25 used similar approaches but used bactaeremic pneumococcal pneumonia and bacteremia respectively instead of all other IPD.…”

“…For non-invasive pneumococcal disease, Smith et al (in all 3 studies), 24,26,27 and Rozenbaum et al (Netherlands), 32 included hospitalized NPP whereas, Weycker et al, 25 Cho et al, 28 Pradas et al, 33 and Boccalini et al, 29 included both hospitalised and non-hospitalized NPP in their analyses. Rozenbaum et al (England) 31 did not include NPP in their (base-case) cost-effectiveness analysis.…”

Review: Current and new generation pneumococcal vaccines

“…25,52 Modelling studies of PCV13 in older adults, including immunocompromised adults, have suggested that a single dose of PCV13 may be more practical economically than previous vaccine recommendations. 25,53,54 In addition, a microsimulation model in which it was assumed that PCV13 efficacy in adults would be comparable to PCV7 in children, together with reasonable assumptions regarding risks and costs of IPD and non-bacteraemic pneumonia, projected that routine PCV13 in place of PPV23 would result in a greater reduction in burden of pneumococcal disease in US adults. 55 The question remains however, as to whether the success of the PCVs can be convincingly extrapolated to adults.…”