Economic evaluation of pneumococcal vaccines for adults aged over 50 years in Belgium

Abstract

Streptococcus pneumoniae causes a high disease burden including pneumonia, meningitis and septicemia. Both a polysaccharide vaccine targeting 23 serotypes (PPV23) and a 13-valent conjugate vaccine (PCV13) are indicated for persons aged over 50 years. We developed and parameterized a static multi-cohort model to estimate the incremental cost-effectiveness and budget-impact of these vaccines at different uptake levels. Using three different vaccine efficacy scenarios regarding non-invasive pneumococcal pneumonia and extensive uni- and multivariate sensitivity analyses, we found a strong preference for PPV23 over PCV13 in all age groups at willingness to pay levels below €300 000 per quality adjusted life year (QALY). PPV23 vaccination would cost on average about €83 000, €60 000 and €52 000 per QALY gained in 50–64, 65–74 and 75–84 year olds, whereas for PCV13 this is about €171 000, €201 000 and €338 000, respectively. Strategies combining PPV23 and PCV13 vaccines were most effective but generally less cost-effective. When assuming a combination of increased duration of PCV13 protection, increased disease burden preventable by PCV13 and a 75% reduction of the PCV13 price, PCV13 could become more attractive in <75 year olds, but would remain less attractive than PPV23 from age 75 years onwards. These observations are independent of the assumption that PPV23 has 0% efficacy against non-invasive pneumococcal pneumonia. Pneumococcal vaccination would be most cost-effective in Belgium, when achieving high uptake with PPV23 in 75–84 year olds, as well as by negotiating a lower market-conform PPV23 price to improve uptake and cost-effectiveness.

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

“…Compared with the low-risk group, the high-risk group could avoid more death and cases, vaccinating with PPSV-23 is more cost-effectiveness. Studies from UK ( 8 ), Japan ( 27 ), and Belgium ( 28 ) have also demonstrated that vaccination with PPSV-23 was a cost-effective intervention for preventing pneumococcal diseases. However, Chen et al ( 29 ) suggest that compared with people who are not vaccinated, vaccination with PPSV-23 is not economical.…”

Cost-effectiveness of the 13-valent pneumococcal conjugate vaccine in adults in Portugal versus “no vaccination” and versus vaccination with the 23-valent pneumococcal polysaccharide vaccine

“…Recent European cost-effectiveness studies of PCV13 vaccination in the adult population that used effectiveness data from the CAPiTA study present considerable variability in results. [39][40][41][42][43][44][45][46][47] The heterogeneity of the results in published literature might be explained by differences in the comparators (PPSV23 or no vaccination), target age for vaccination, assumptions regarding resource use and costs, approaches followed to include the indirect effect of childhood vaccination in the models, dynamics of vaccination serotype coverage over time, calibration of the PPSV23 effectiveness and the incidence rate of IPD in adult population, in particular of hospitalized pneumonia.…”

A global agenda for older adult immunization in the COVID-19 era: A roadmap for action

“…Many studies have shown that vaccines against influenza [44,45], pneumococcus [46][47][48][49] and herpes zoster [50][51][52] are cost-effective when given to older adults in a range of settings [53]. Notwithstanding this, the corresponding global economic burden offset by these adult VPD vaccines has not been fully calculated.…”