Economic analysis of 15-valent and 20-valent pneumococcal conjugate vaccines among older adults in Ontario, Canada.

IF 5.5 3区医学 Q1 IMMUNOLOGY

Expert Review of Vaccines Pub Date : 2025-12-01 Epub Date: 2025-04-07 DOI:10.1080/14760584.2025.2488495

Gebremedhin B Gebretekle, Ryan O'Reilly, Stephen Mac, Shaza Fadel, Natasha S Crowcroft, Beate Sander

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引用次数: 0

Abstract

Background: Health Canada approved two new pneumococcal conjugate vaccines (PCV), 15-valent (PCV15) and 20-valent (PCV20), and we assessed their cost-effectiveness for older Ontarians.

Research design and methods: We conducted a cost-utility analysis using an individual-level state transition model to compare one dose of PCV (alone or in series with PPV23) with PPV23-only. We estimated incremental cost-effectiveness ratios (ICERs) expressed in costs (C$2022) per quality-adjusted life year (QALY) from the healthcare payer perspective, discounted at 1.5% annually.

Results: A sequential comparison of vaccinations with no indirect effect from childhood vaccination resulted in an ICER of $44,324/QALY for PCV15-alone compared to PPV23-only, and $70,751/QALY for PCV20-alone versus PCV15-alone. None of the PCV15/20 combined with PPV23 programs were cost-effective at a C$50,000/QALY threshold. PCV20 alone had an ICER of C$46,961/QALY compared to PPV23-only. When considering indirect effects, PCV15/20 alone or in series with PPV23 were not cost-effective. ICERs were mostly influenced by vaccine characteristics (effectiveness, waning, cost) and the incidence of pneumococcal community-acquired pneumonia.

Conclusions: Vaccinating older adults with PCV15/20 likely reduces burden of pneumococcal disease and would be cost-effective initially, but is expected to be less economically attractive in the longer term when herd immunity benefits from childhood vaccination programs are considered.

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背景：加拿大卫生部批准了两种新的肺炎球菌结合疫苗（PCV）：15价（PCV15）和20价（PCV20），我们评估了它们对安大略省老年人的成本效益：我们使用个人水平的状态转换模型进行了成本效用分析，比较了一剂 PCV（单独或与 PPV23 系列）与仅 PPV23 的效果。我们从医疗支付方的角度估算了以每质量调整生命年（QALY）成本（2022 加元）表示的增量成本效益比（ICER），每年贴现率为 1.5%：在儿童接种无间接影响的情况下，对接种疫苗进行顺序比较，结果显示 PCV15 单次与仅 PPV23 相比，ICER 为 44,324 美元/QALY；PCV20 单次与 PCV15 单次相比，ICER 为 70,751 美元/QALY。在 50,000 加元/QALY 临界值下，PCV15/20 与 PPV23 联合方案均不具成本效益。与仅使用 PPV23 相比，仅 PCV20 的 ICER 为 46,961 加元/QALY。如果考虑到间接效应，单独 PCV15/20 或与 PPV23 系列接种都不具有成本效益。ICER主要受疫苗特性（有效性、减弱、成本）和肺炎球菌社区获得性肺炎发病率的影响：结论：为老年人接种 PCV15/20 有可能减轻肺炎球菌疾病的负担，并且在初期具有成本效益，但如果考虑到儿童疫苗接种计划带来的群体免疫效益，预计从长远来看其经济吸引力会降低。

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

Expert Review of Vaccines 医学-免疫学

CiteScore

9.10

自引率

3.20%

发文量

136

审稿时长

4-8 weeks

期刊介绍： Expert Review of Vaccines (ISSN 1476-0584) provides expert commentary on the development, application, and clinical effectiveness of new vaccines. Coverage includes vaccine technology, vaccine adjuvants, prophylactic vaccines, therapeutic vaccines, AIDS vaccines and vaccines for defence against bioterrorism. All articles are subject to rigorous peer-review. The vaccine field has been transformed by recent technological advances, but there remain many challenges in the delivery of cost-effective, safe vaccines. Expert Review of Vaccines facilitates decision making to drive forward this exciting field.