Determining the Optimal Pneumococcal Vaccination Strategy for Adults

Metersky, Mark L.; Jackson, Lisa A.

doi:10.1378/chest.10-0738

Cited by 32 publications

(24 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Deaths were modeled using US mortality tables 24 . For hospitalized NPP rates, we extrapolated from all-cause pneumonia hospitalization rates (Table 2), estimating that pneumococcal pneumonia accounts for 30% of all-cause pneumonia hospitalizations 3, 12, 25 . We used National Hospital Discharge Survey data 26 for our base case analysis, with Nationwide Inpatient Sample data 6 used in sensitivity analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Most studies show that PPSV23 provides some protection against IPD, but studies have reached contradictory conclusions for its prevention of nonbacteremic pneumococcal pneumonia (NPP) 1-2 , which causes several hundred thousand illnesses annually in the US 3 . Large randomized controlled trials of PPSV23 conducted in developed countries have not found evidence of efficacy against NPP among community-dwelling older adults or among younger adults with chronic illness 1, 4-5 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine

Smith¹,

Wateska²,

Nowalk³

et al. 2012

JAMA

123

140

View full text Add to dashboard Cite

Context The cost-effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) compared with 23-valent pneumococcal polysaccharide vaccine (PPSV23) among US adults is unclear. Objective To estimate the cost-effectiveness of PCV13 vaccination strategies in adults to assist vaccination policy decision-making. Design, Setting, and Population A Markov state-transition model, lifetime time horizon, societal perspective. Simulations were performed in hypothetical cohorts of US 50-year-olds. Vaccination strategies and effectiveness estimates were developed by a Delphi expert panel; indirect (herd immunity) effects resulting from childhood PCV13 vaccination were extrapolated based on observed PCV7 effects. Data sources for model parameters included CDC Active Bacterial Core surveillance, National Hospital Discharge Survey and Nationwide Inpatient Sample data, and the National Health Interview Survey. Main Outcome Measures Pneumococcal disease cases prevented and incremental costs per quality-adjusted life year (QALY) gained. Results In the base case scenario, PCV13 given as a substitute for PPSV23 in current recommendations (i.e., vaccination at 65 years and at younger ages if comorbidities are present) cost $28,900/QALY gained compared with no vaccination and was more cost-effective than the currently recommended PPSV23 strategy. Routine PCV13 at ages 50 and 65 years cost $45,100/QALY compared with PCV13 substituted in current recommendations. Adding PPSV23 at age 75 to PCV13 at ages 50 and 65 years gained 0.00002 QALYs, costing $496,000/QALY gained. Results were robust in sensitivity analyses and alternative scenarios, except when low PCV13 effectiveness against nonbacteremic pneumococcal pneumonia was assumed or when greater childhood vaccination indirect effects were modeled. In these cases, PPSV23 as currently recommended was favored. Conclusions Overall, PCV13 vaccination was favored compared to PPSV23, but the analysis is sensitive to assumptions about PCV13 effectiveness against NPP and the magnitude of potential indirect effects from childhood PCV13 on pneumococcal serotype distribution.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine

Smith¹,

Wateska²,

Nowalk³

et al. 2012

JAMA

123

140

View full text Add to dashboard Cite

show abstract

“…NPP rates were calculated from National Hospital Discharge Survey data[17] under the assumption that 30% of all hospitalized pneumonia cases are caused by pneumococci (Table 1, bottom). [18, 19] As previously, we assumed that the serotype distribution of NPP was similar to IPD and that NPP and IPD case rate ratios were the same among comorbidity groups. [16] Disability after hospitalized NPP was modeled as 50% of the IPD value and varied widely in sensitivity analyses.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults

Nowalk

Raymund

Zimmerman

2013

Vaccine

View full text Add to dashboard Cite

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.

show abstract

“…Indeed, in the USA over 90 per cent of the reduction in hospitalizations attributable to pneumococcal conjugate vaccination of infants, occurs through prevention of pneumonia in adults [17]. Conjugate vaccines are currently in clinical trial in adults-their effectiveness is of great interest but may be limited in countries where the same vaccines are given to children [28].…”

Section: Children Play a Significant Role In Pneumococcal Disease Tramentioning

confidence: 99%

Contribution of vaccines to our understanding of pneumococcal disease

Klugman

2011

Phil. Trans. R. Soc. B

View full text Add to dashboard Cite

Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibioticresistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.

show abstract

Determining the Optimal Pneumococcal Vaccination Strategy for Adults

Cited by 32 publications

References 41 publications

Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine

Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine

Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults

Contribution of vaccines to our understanding of pneumococcal disease

Contact Info

Product

Resources

About