Economic Evidence of Pneumococcal Vaccination in Older Adults: Uncertain Modelling or Competitive Tendering?

Vaccination against Pneumococcus and Influenza in Old Age: Evidence- Based Geriatrics

“…The CAPiTA study (Community-Acquired Pneumonia Immunization Trial in Adults, a Dutch clinical trial supported by the manufacturer) showed that PCV13 is efficacious in preventing two thirds of BPP (75%) and around half the NBPP (45%) cases in older adults [4]. The Spanish CAPAMIS (Community-Acquired Pneumonia, Acute Myocardial Infarction and Stroke) cohort study (funded by public authorities) confirmed that PPV23 is effective against both BPP (62%) and NBPP (48%) in adults older than 60 years [4].…”

“…Streptococcus pneumoniae causes 400,000 hospitalizations each year, and 18,000 cases of invasive pneumococcal disease occur yearly with a case-fatality rate of 20% [3]. Diseases caused by Streptococcus pneumonia contribute considerably to morbidity and mortality worldwide [4].…”

“…On the other hand, Influenza virus is responsible for 250,000 deaths yearly and it's associated with 3-5 million cases of severe infection [5]. The risk of influenza-related death increases exponentially after the age of 65 years old, and in elderly population represents more than 90% of overall influenza related mortality annually [3][4][5][6]. Thus seasonal influenza epidemics place a heavy socioeconomic burden on both adults and the elderly [7].…”

“…Vaccines are one of the most cost-effective strategies because they offer a cheap alternative of preventing potential morbidity. Aging related to the increase of infections among older people make vaccination and its research an imperative issue [4,7].…”

Vaccination planning in Italy: increasing vaccines while reducing coverage?

“…As recently underlined by the national Antitrust Authority (Autorità Garante della Concorrenza e del Mercato, AGCM) [8], potential competition may be exploited further for traditional vaccinations, owing to new multivalent vaccines being marketed (two hexavalent for diphtheriahepatitisB-pertussis-polio-tetanus-haemophilus influenza b and two quadrivalent for measles-rubellaparotitis-varicella), for HPV and PCV vaccinations, although with very uneven results for the two last ones so far -impressive for HPV [9] and negligible for PCV [2]. While the male extension for HPV could contribute to a further decrease of the prices awarded in regional tenders (€28.60 per dose [10] the lowest at present), the combined schedule of PCV13 and PPV23 foreseen for the extension of pneumococcal vaccination to older adults will preclude any kind of price competition in practice, although the difference between the two vaccines is less relevant for this target population [11,12]. There is little potential competition for herpes zoster and meningococcal vaccines, since only one manufacturer markets them, while two vaccines are available against rotavirus.…”