Cost effectiveness of a 21-valent pneumococcal conjugate vaccine in adults: A systematic review of economic evaluations.

Abstract

Background: In July 2024, Health Canada authorized a 21-valent pneumococcal conjugate vaccine (Pneu-C-21) for use in adults.

Objective: To conduct a systematic review of the cost-effectiveness of Pneu-C-21 for preventing pneumococcal disease in adults.

Methods: We conducted a systematic search of the literature and National Immunization Technical Advisory Groups' websites on July 3, 2024. We included economic evaluations that assessed Pneu-C-21 as a vaccination strategy among adults aged 18 years and older. Costs were adjusted to 2023 Canadian dollars.

Results: We identified 10 studies in our search, five of which were summarized in our review. No economic evaluations were conducted in Canada. All economic evaluations used static cohort models and incorporated indirect effects from paediatric pneumococcal conjugate vaccination in primary or sensitivity analyses. Although incremental cost-effectiveness ratios were heterogeneous across included economic evaluations, overall, they qualitatively identified the same vaccination strategies as optimal within the given age and risk groups. Pneu-C-21 is likely to be cost-effective in adults aged 65 years and older and adults under the age of 65 years with specific high risk conditions.

Conclusion: Pneu-C-21 is likely to be cost-effective in adults within specific age and risk groups. The applicability of the included economic evaluations to adults living in Canada is limited because the serotype-specific incidence of pneumococcal disease and the impact of indirect effects from pediatric vaccination varies by region and over time.