Cost-effectiveness and budget impact analyses of the 24-valent pneumococcal conjugate vaccine in adults aged 50 and older.

IF 3.5
Shoroq M Altawalbeh, Angela R Wateska, Mary Patricia Nowalk, Chyongchiou J Lin, Lee H Harrison, William Schaffner, Richard K Zimmerman, Kenneth J Smith
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Abstract

A 24-valent pneumococcal conjugate vaccine (PCV24) is currently in development and could potentially be used in all adults aged 50 years and older. This study evaluated risk- and age-based PCV24 use to ascertain its potential public health effects, budget impact, and cost-effectiveness. A Markov decision analysis model compared PCV24 and all currently recommended pneumococcal vaccines. Age-based vaccination could occur at age 50 or at ages 50 and 65. The analysis separately examined hypothetical cohorts of U.S. Black and non-Black individuals with and without consideration of childhood pneumococcal vaccination indirect effects, using race-specific pneumococcal disease and vaccination data. Cohorts were tracked over a lifetime horizon from both societal and healthcare perspectives. Model parameters were derived from U.S. data and parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Budgetary impact of 21-valent conjugate vaccine (PCV21), PCV24, and combinations of both at different ratios was also assessed. From societal and healthcare perspectives, PCV24 prevented fewer pneumococcal disease cases and deaths but was less economically favorable than strategies using PCV21. Other vaccines were similarly less favorable than PCV21. When adding childhood vaccination indirect effects, PCV24 strategies remained unfavorable compared to PCV21 strategies. In probabilistic sensitivity analyses, PCV21 at ages 50 and 65 was preferred in 99 % of model iterations for Black cohorts and 85 % for non-Blacks at a $100,000/QALY willingness-to-pay threshold. Budget impact for PCV24 and PCV21 were not substantially different but PCV21 prevented more hospitalizations and deaths. Compared to PCV21, which is formulated solely on adult pneumococcal epidemiology, PCV24 and other childhood epidemiology-formulated vaccines were less economically favorable among adults aged 50 and older. Budget impacts of PCV21 and PCV24 use were similar.

50岁及以上成人24价肺炎球菌结合疫苗的成本效益和预算影响分析
一种24价肺炎球菌结合疫苗(PCV24)目前正在开发中,可能用于所有50岁及以上的成年人。本研究评估了基于风险和年龄的PCV24的使用,以确定其潜在的公共卫生影响、预算影响和成本效益。马尔可夫决策分析模型比较了PCV24和所有目前推荐的肺炎球菌疫苗。基于年龄的疫苗接种可以在50岁或50岁和65岁时进行。该分析使用种族特异性肺炎球菌疾病和疫苗接种数据,分别检查了考虑和不考虑儿童肺炎球菌疫苗间接影响的美国黑人和非黑人个体的假设队列。从社会和医疗保健的角度对这些人群进行了终身跟踪。模型参数来源于美国数据,并通过确定性和概率敏感性分析评估参数的不确定性。还评估了不同比例的21价结合疫苗(PCV21)、PCV24以及两者的组合对预算的影响。从社会和卫生保健角度来看,PCV24预防的肺炎球菌疾病病例和死亡较少,但在经济上不如使用PCV21的策略有利。其他疫苗同样不如PCV21有利。当加入儿童疫苗接种的间接效应时,PCV24策略与PCV21策略相比仍然不利。在概率敏感性分析中,在10万美元/QALY支付意愿阈值下,50岁和65岁的PCV21在99%的黑人队列模型迭代中被优选,在85%的非黑人队列中被优选。PCV24和PCV21对预算的影响没有实质性差异,但PCV21预防了更多的住院和死亡。与仅针对成人肺炎球菌流行病学配制的PCV21相比,PCV24和其他儿童流行病学配制的疫苗在50岁及以上的成年人中经济上不太有利。使用PCV21和PCV24对预算的影响相似。
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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