Background: The National Advisory Committee on Immunization (NACI) recommends broad use of PCV13 in infants, the 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults ≥65 years, and both vaccines sequentially for adults with immunocompromising conditions. In light of recent PCV13 efficacy results from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), and new sero-epidemiology data on pneumonia caused by PCV13 serotypes in Canadian adults, we examined the economic implications of funding an expanded PCV13 immunization program.
Methods: A microsimulation model depicting expected lifetime risks,
consequences, and costs of invasive pneumococcal disease (IPD) and all-cause
pneumonia (ACP) in Canadian adults was developed. PPV23 effectiveness was based
on published literature; PCV13 effectiveness was based on data from
CAPiTA. Rates of ACP in different age
groups were estimated from the Canadian Institute of Health Information
hospital Discharge Abstract Database (CIHI DAD). The proportion of ACP caused
by PCV13 serotypes was estimated from the Serious Outcomes Surveillance (SOS)
Network using serotype-specific urinary antigen detection assay. Herd effects
were included in the model based on previous observations with PCV7 in Canada.
Outcomes and costs were evaluated for three alternative populations: (1)
immunocompromised persons 18-99 at model entry (n=1.4M); (2) immunocompromised
persons 18-64 and all persons ≥65 at model entry (n=6.2M); and (3)
immunocompromised and high-risk persons 18-64 and all persons ≥65 at
model entry (n=13.8M). Vaccination
Results: Implementing an expanded program with PCV13 followed by PPV23 (in lieu of PPV23 alone) would be cost saving for populations 1 & 2 and highly cost-effective for population 3 (Table).
Table. Cost-effectiveness of proposed strategies for expanded use of PCV13
Conclusion: Implementing the proposed vaccine program with PCV13 followed by PPV23 in Canadian adults would be cost-saving or a highly cost-effective use of scarce healthcare resources.
R. Sato, Pfizer Inc.: Employee and Shareholder , Salary
L. Beausoleil, Pfizer Canada Inc: Employee , Salary
C. Laferriere, Pfizer Canada: Employee and Shareholder , Salary
S. A. Mcneil, Pfizer Canada Inc.: Grant Investigator and Scientific Advisor , Grant recipient