657. Public Health & Economic Impact of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Adult Vaccination in the Context of a Flu Pandemic in the US
Session: Poster Abstract Session: Pneumococcal Vaccines
Friday, October 21, 2011
Room: Poster Hall B1
Background: Influenza (“flu”) deaths during the 1918 pandemic are linked to pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) is recommended for children aged ≤5 years, while 23-valent polysaccharide vaccine (PPSV23) is recommended for all adults ≥65 and at-risk groups aged 2-64. PCV13 is under FDA consideration for use in adults aged ≥50.  We evaluated the cost-effectiveness of adult PCV13 vs PPSV23 in the context of a US flu pandemic.

Methods: A 20-year microsimulation compared adult vaccination with PCV13 (≥50 with PCV13 and at-risk 18-49 with PPSV23, no revaccination) vs PPSV23 (≥65 and at-risk 18-64, no revaccination). Scenario analysis compared PCV13 (≥50 and at-risk 18-49 with PCV13, revaccination every 10 years) with PPSV23. PCV13 efficacy was extrapolated from pediatric PCV7 efficacy; expected indirect effects of PCV13 pediatric vaccination on adult incidence were included. Model was estimated from published studies and assumes a pandemic (30% flu incidence) in the 10th year. Vaccine costs were $113 for PCV13 vs $49 for PPSV23. Outcomes are meningitis and bacteremia cases (invasive pneumococcal disease [IPD]), all-cause pneumonia cases, mortality, costs, and quality-adjusted life-years (QALYs).

Results: PCV13 prevents an additional 110,000 IPD and 1.7 pneumonia cases (Table) and 24,000 IPD and 80,000 pneumonia deaths; and results in 550,000 QALYs gained vs PPSV23. Additional vaccine costs are $7.5B; savings due to averted cases of IPD, hospitalized and non-hospitalized pneumonia are $1.6B, $7.2B and $208M, respectively. PCV13 is less costly ($237 vs. $239B) and more effective, and remains cost-saving ($2.2B savings) and more effective (1.1M QALYs gained) in the scenario analysis. Assuming no protection of PCV13 vs pneumonia, the incremental cost-effectiveness ratio compared to PPV23 was <$35,000/QALY.

Conclusion: PCV13 adult vaccination would substantially reduce pneumococcal cases and deaths and save >$1.5 billion during a 20-year period that includes a flu pandemic.

Table. Cases averted – PCV13 vs PPSV23, 20-year model with flu pandemic in year 10

Age Group (yrs)

IPD

Pneumonia

Hospitalized

Non-hospitalized

18-49

1,992

0

0

50-64

50,046

206,602

342,470

65+

57,996

687,072

473,092

Total

110,034

893,673

815,562


Subject Category: I. Adult and Pediatric Vaccines

Lisa McGarry, MPH1, Gregory Hill, BA1, Kristen Gilmore, BA1, Reiko Sato, Ph.D.2, David Strutton, Ph.D.2, Jaime Rubin, MA3 and Milton Weinstein, PhD1,4, (1)OptumInsight, Medford, MA, (2)Pfizer, Inc., Collegeville, PA, (3)DaVita Clinical Research, Minneapolis, MN, (4)Harvard School of Public Health, Boston, MA

Disclosures:

L. McGarry, Pfizer Inc.: Consultant, Consulting fee

G. Hill, Pfizer Inc.: Consultant, Consulting fee

K. Gilmore, Pfizer Inc.: Consultant, Consulting fee

R. Sato, Pfizer Inc.: Employee, Salary

D. Strutton, Pfizer Inc.: Employee, Salary

J. Rubin, Pfizer Inc.: Consultant, Consulting fee

M. Weinstein, Pfizer Inc.: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.