Background: There is currently no data on the age- and risk-group specific cost-effectiveness of the 13 valent pneumococcal vaccine (PCV13) compared to the 23 valent polysaccharide vaccine (PPV23). The aim of this study was to evaluate the cost-effectiveness of vaccinating these specific groups against pneumococcal disease.
Methods: A previously published and independently validated (by The Dutch National Health-Care Institute) age-and risk-group specific Markov-type model was used to compare the cost-effectiveness of PCV13 vaccination versus PPV23 vaccination of all adults at increased risk of pneumococcal disease (i.e. adults with underlying disease and those ≥50 years). Efficacy estimates for PCV13 were extrapolated from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Efficacy estimates for PPV23 were based on systematic literature reviews and other published data.
Results: At list price (68.56 for PCV13 and 19.99 for PPV23), vaccination of all adults at increased risk of pneumococcal disease resulted in an ICER of 20,186/QALY, while vaccinating those with chronic medical conditions (moderate risk) and immunocompromising conditions (high risk) resulted in an ICER of <10,000/QALY . Large differences in ICERs between age-and risk-groups were observed(Table). Vaccinating, high risk individuals with PCV13 was cost-saving for those aged less than 65 years of age compared to PPV23 while vaccinating those aged 85 years and older with PCV13 was moderate cost-effective with an ICER of 60,900/QALY. Vaccinating moderate risk individuals was highly cost-effective (<20,000/QALY), while vaccinating those with low-risk of pneumococcal infection was cost-effective (<50,000/QALY). However, within risk groups the ICER differed significantly between age groups. Sensitivity analysis showed that a proportional decrease in list price, such as common in national vaccination programs, decreased the ICER disproportionally in favour of PCV13.
Conclusion: Vaccination all adults with PCV13 is cost effective compared to PPV23. There is a large variation in the cost-effectiveness between age and risk groups. Targeting individuals with underlying diseases aged less than 85 years would provide most value for money.
M. Rozenbaum, Pfizer: Employee and Shareholder , Salary .