Cost-effectiveness of 15-valent or 20-valent pneumococcal conjugate vaccine for U.S. adults aged 65 years and older and adults 19 years and older with underlying conditions

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2025-01-12 DOI:10.1016/j.vaccine.2024.126567

Melissa Rosenthal , Charles Stoecker , Andrew J. Leidner , Bo-Hyun Cho , Tamara Pilishvili , Miwako Kobayashi

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引用次数: 0

Abstract

Background

In June 2021, the Advisory Committee on Immunization Practices (ACIP) recommended use of either 20-valent pneumococcal conjugate vaccine (PCV20) alone or 15-valent pneumococcal conjugate vaccine (PCV15) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all PCV-unvaccinated adults aged ≥65 years (age-based) and for adults aged 19–64 years with conditions that increase the risk for pneumococcal disease (risk-based). This recommendation replaced a previous recommendation for PPSV23 with or without 13-valent pneumococcal conjugate vaccine (PCV13) for these groups.

Objective

We conducted a cost-effectiveness analysis of age-based and risk-based use of either PCV15 in series with PPSV23 or PCV20 alone when compared to previous recommendations.

Methods

We utilized probabilistic cohort models of all 65-year-olds (age-based) and 19-year-olds (risk-based through age 64 years and age-based at age 65 years). A spreadsheet-based Monte Carlo simulation software was used to estimate immunization costs, medical costs, non-medical costs, and overall disease burden under different vaccine strategies. The model tracked inpatient invasive pneumococcal disease (IPD) and non-bacteremic pneumonia (NBP) in inpatient and outpatient settings. One-way sensitivity analyses incorporated indirect effects of prospective pediatric vaccination with PCV15 and PCV20 on adult IPD and NBP incidence. Costs were reported in 2021 US dollars. All future costs and outcomes were discounted at 3 % per year.

Results

Age-based use of either PCV20 alone or PCV15 in series with PPSV23 at age 65 years were both shown to be cost-saving (improved health outcomes and saved costs). Combined cost-effectiveness of risk-based (19–64 years) plus age-based (65 years) (risk-and-age-based) use of PCV20 alone was cost-saving, whereas use of PCV15 in series with PPSV23 increased quality-adjusted life years (QALYs) but cost $412,111 (95 % CI: 270,295, 694,869) per QALY gained.

Conclusion

In U.S. adults, replacing the previous recommendations with PCV20 alone or PCV15 in series with PPSV23 improved health outcomes. Except for risk-and-age-based use of PCV15 in series with PPSV23 that resulted in increased cost per QALY gained, the interventions also reduced costs.

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美国65岁及以上成年人和19岁及以上有潜在疾病的成年人使用15价或20价肺炎球菌结合疫苗的成本效益

背景：2021年6月，免疫实践咨询委员会（ACIP）建议对所有未接种pcv疫苗的年龄≥65岁（基于年龄）和年龄在19-64岁且肺炎球菌疾病风险增加的成年人（基于风险）单独使用20价肺炎球菌结合疫苗（PCV20）或15价肺炎球菌结合疫苗（PCV15）与23价肺炎球菌多糖疫苗（PPSV23）串联使用。这一建议取代了之前针对这些人群的PPSV23联合或不联合13价肺炎球菌结合疫苗（PCV13）的建议。目的：我们对基于年龄和风险的PCV15联合PPSV23或单独使用PCV20进行了成本-效果分析，并与之前的建议进行了比较。方法：我们使用了所有65岁（基于年龄）和19岁（基于风险至64岁和基于年龄至65岁）的概率队列模型。使用基于电子表格的蒙特卡罗模拟软件估算不同疫苗策略下的免疫成本、医疗成本、非医疗成本和总体疾病负担。该模型跟踪住院和门诊的侵袭性肺炎球菌病（IPD）和非菌源性肺炎（NBP）。单向敏感性分析纳入了前瞻性儿童接种PCV15和PCV20对成人IPD和NBP发病率的间接影响。成本以2021年的美元计算。所有未来成本和结果均以每年3%的折现率计算。结果：基于年龄的使用PCV20单独或PCV15与PPSV23在65岁时串联均显示出成本节约（改善健康结果和节省成本）。基于风险（19-64岁）和基于年龄（65岁）（基于风险和年龄）单独使用PCV20的综合成本效益节省了成本，而PCV15与PPSV23联合使用增加了质量调整生命年（QALY），但每个获得的QALY成本为412,111美元（95% CI: 270,295, 694,869）。结论：在美国成年人中，用PCV20单独或PCV15与PPSV23联合替代先前的推荐可改善健康结果。除了基于风险和年龄将PCV15与PPSV23串联使用导致每获得的QALY成本增加外，干预措施还降低了成本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

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