Estimating the cost-effectiveness of a sequential pneumococcal vaccination program for adults in Germany

Abstract

IntroductionIn Germany, a 23-valent polysaccharide pneumococcal vaccine (PPSV23) is recommended for elderly (60+) and patients 16+ with chronic diseases not associated with immune suppression. For all other patients at risk, sequential immunization with a 13-valent pneumococcal conjugate vaccine (PCV13) first, followed by PPSV23 is recommended. Repeated vaccination with PPSV23 is recommended every 6 years after individual assessment by the physician. This was adopted into the vaccination directive with binding reimbursement and funding. However, additional voluntary services allow statutory health insurances to differentiate from each other. Aim of this study is to estimate the cost-effectiveness of voluntary service scenarios compared to the strategy in place to support informed decision making.MethodsA microsimulation framework with Markov-type process of a population susceptible to pneumococcal disease over a lifetime horizon was developed to compare effectiveness and cost-effectiveness of different vaccination strategies. We simulated 1,000 iterations for seven scenarios. Assumptions were derived from published literature and probabilistic sensitivity analysis was run to show the robustness of the model.ResultsOur study indicates that all voluntary service strategies could prevent further clinical cases compared to the existing policy. Depending on the scenario, 48–142 invasive pneumococcal disease (IPD), 24,000–45,000 hospitalized all-cause nonbacteremic pneumonia (NBP), 15,000–45,000 outpatient NBP cases, and 4,000–8,000 deaths could be avoided on average. This refers to potential savings of €115 Mio. - €187 Mio. for medical and non-medical costs. Additional costs per patient for the payer are €2.48 to €7.13 and for the society €2.20 to €6.85. The ICER per LYG ranged from €3,662 to €23,061 (payer) and €3,258 to €29,617 (societal). All but one scenario was cost-effective in ≥60% of the generated 1,000 simulations.ConclusionCompared to the vaccination strategy in place, the different hypothetical scenarios can be considered cost-effective and suitable as additional voluntary services.

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.…”

Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions

“…2). Of these, 13 economic evaluations were selected for the assessment of quality [8][9][10][24][25][26][27][28][29][30][31][32][33], and the remaining 15 studies [34][35][36][37][38][39][40][41][42][43][44][45][46] were excluded from further analysis and are summarized in the ESM (file S2).…”

“…Of them, five studies [8-10, 25, 30] derived estimates of the vaccine-age-interaction effect from a post-hoc analysis of the CAPiTA data [50,51] (see Table 2). Another study [33] assumed that the age-vaccine-interaction effect for PCV13 is 50% lower than the effect for PPSV23. Two studies [27,31] applied age-group-specific variations of the initial PCV13 VE.…”

“…Three studies applied VE of 39% [24], 30.8% [10], and 19.6% [32] based on other empirical studies [48,57]. Four studies [27,30,31,33] applied vaccine-age-interaction effects for PPSV23. Only Kuchenbecker et al [33] and Dirmesropian et al [30] reported single-age-specific initial VE for PPSV23.…”

“…Four studies [27,30,31,33] applied vaccine-age-interaction effects for PPSV23. Only Kuchenbecker et al [33] and Dirmesropian et al [30] reported single-age-specific initial VE for PPSV23. Dirmesropian et al [30] applied a logistic function that was calibrated for ≥ 75 year-olds based on data from the study by Andrews et al [15].…”