Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States

Abstract

BACKGROUND:Recently released results from a randomized controlled trial have shown that 13-valent pneumococcal conjugate vaccine (PCV13) is efficacious against vaccine-type nonbacteremic pneumonia in adults. OBJECTIVE: We examined the incremental costeffectiveness of adding PCV13 to the Advisory Committee on Immunization Practices (ACIP) adult immunization schedule. METHODS:We used a probabilistic model following cohorts of 50-, 60-, or 65-year-olds. We used separate vaccination coverage and disease incidence data for healthy and highrisk adults. Incremental cost-effectiveness ratios were determined for each potential vaccination strategy. RESULTS: In the base case scenario, our model indicated that adding PCV13 at age 65 or replacing 23-valent pneumococcal polysaccharide vaccine (PPSV23) at age 65 with PCV13 provided more value for money than adding PCV13 at ages 50 or 60. After projections of six additional years of herd protection from the childhood immunization program were incorporated, we found adding PCV13 dominated replacing PPSV23. For a cohort of 65-yearolds in 2013, the cost of adding PCV13 at age 65 to the schedule was $62,065 per quality-adjusted life year (QALY) gained, which rose to $272,621 after 6 years of projected herd protection. CONCLUSION: The addition of one dose of PCV13 for adults appears to have a cost-effectiveness ratio comparable to other vaccination interventions in the short run, though anticipated herd protection from the childhood immunization program may dramatically increase the cost per QALY after only a few years.

An intervention to improve pneumococcal vaccination uptake in high risk 50-64 year olds vs. expanded age-based recommendations: an exploratory cost-effectiveness analysis

“…This study shows a reduction in pneumococcal disease when adding PCV13 to the regimen, similar to another analysis comparing current recommendations with PCV13 recommendation for high risk patients; however cost outcomes are not comparable because that study did not examine a strategy of vaccinating everyone aged 50-64, regardless of comorbidity status. 23 A CE analysis evaluating PCV13 vaccination in healthy adults with no high risk conditions over 50 years in Belgium compared to PPSV23 vaccination and both vaccines combined resulted in a higher ICER for PCV13 than that seen in our study. When comparing PCV13 with PPSV23, the cost and effectiveness of each were similar, with the higher price of PCV13 being the driving factor in a higher ICER for PCV13.…”

“…As part of the sensitivity analysis, we focused on a secondary baseline value of 24.5% for PCV13 pneumococcal illness serotype coverage likelihood, based on updated CDC serotype likelihood data (2015-2016, unpublished data), slightly lower than values in a recent CDC analysis (24.8-26.75%). 23 Death due to non-pneumococcal causes was modeled using U.S. mortality data. 45 In the base case analysis, equal nonpneumococcal mortality risk was assumed in average-and high-risk health states, thus making model assumptions more favorable toward strategies where only high-risk patients are vaccinated; this assumption was tested in sensitivity analyses, where the effects of higher mortality in highrisk patients were examined.…”

“…32 More recently, Weycker et al estimated hospitalized NBP as 193/100,000 in 50-64 year-olds. 33 In their 2016 CE analysis of adult pneumococcal vaccination strategies, Stoecker et al 23 23 At the other end of the spectrum, Jain et al, in a surveillance-based study, found all-cause pneumonia hospitalization rates in 50-64 year-olds to be 263/100,000 with S. pneumoniae detected in 5% or 13/100,000. 35 However, this study detected no pathogen in 64% of cases, a 194/100,000 population likelihood of hospitalized pneumonia with no pathogen detected in this age range, 35 leaving open the question of what the true likelihood of NBP is, given the difficulty of establishing this diagnosis.…”

Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey

“…A more recent review by Treskova et al (2019) 18 stratifies the newer literature according to assumptions about herd effects from pediatric vaccination (i.e., whether effects were ongoing or completed, whether effects were from pediatric PCV13 (PCV13 Pediatric) or from pediatric 10-valent pneumococcal conjugate vaccine (PCV10 Pediatric), or whether there was a switch in pediatric vaccination from PCV10 to PCV13 or vice versa), and according to the policy being evaluated (PPV23 versus no vaccination, PCV13 versus no vaccination, and adding PCV13 to PPV23). Of the four studies that evaluate the addition of PCV13 Adult to adult PPV23 (as was the case in Turkey), van Hoek and Miller (2016), 20 Blommaert et al (2016), 21 and Willem et al (2018) 22 found doing so to be cost-ineffective, while Stoecker et al (2016) 23 found it to be cost-effective only in the short run before herd effects fully set in. Treskova et al (2019) 18 conclude from this evidence that PCV13 Adult is not cost-effective in the presence of herd effects from PCV13 Pediatric.…”

Simplified Pneumococcal Vaccination Schedules for Adults Age 50 and Over Lead to Worse Health

“…In our model we projected these rates forward to account for the indirect protection provided by additional serotypes in PCV13 not covered by the 7-valent version [9][10][11][12].…”