{"title":"接种过疫苗的年轻人呢？PCV21在19-64岁有潜在疾病且接种过疫苗的美国成年人中使用的成本效益","authors":"Zinan Yi, Elamin H Elbasha, Kwame Owusu-Edusei","doi":"10.1016/j.amepre.2025.108159","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Because of the residual pneumococcal disease burden among vaccineexperienced adults aged 19-64 years with underlying medical conditions in the United States (US), the Advisory Committee on Immunization Practices (ACIP) recommended revaccination with higher valent pneumococcal conjugate vaccine (PCV). Following PCV21's 2024 introduction, it was added as an option. This study evaluated the cost‑effectiveness of PCV21 versus the recommended alternatives (PPSV23, PCV15, and PCV20) in this population.</p><p><strong>Methods: </strong>A published static multi-cohort state-transition Markov model was used to estimate the lifetime incremental clinical and societal economic outcomes of administering a single dose of PCV21 in adults aged 19-64 years who were previously vaccinated 5 years ago with PPSV23 or PCV13, or 2 years ago with PCV15. The estimated total quality-adjusted life years (QALYs) and costs (in 2023 USD) were discounted at an annual rate of 3%, as well as the incremental cost-effectiveness ratios (ICERs) reported as $/QALY gained. Probabilistic/Deterministic sensitivity analysis (PSA/DSA) and scenario Analysis was conducted.</p><p><strong>Results: </strong>Among 19-49 year-olds, compared with PPSV23, the ICER of PCV21 in the PCV13- and PCV15-experienced adults was $99,700 and $149,300, respectively. PCV21 was cost-saving versus PCV15 in the PPSV23-experienced and versus PCV20 across all vaccine-experienced population. Among 50-64 year-olds, compared with PPSV23, the ICER of PCV21 was $62,400/QALY in PCV13-experienced and $85,400 in PCV15-experienced. PCV21 was cost-saving compared with PCV15 or with PCV20 across all vaccine-experienced population. The DSA identified that discount rates and vaccine effectiveness were the most influential inputs. The PSA confirmed the results' robustness. The scenario analysis showed only minor changes in ICER when the time since last vaccination extended to 8 years for the PPSV23 or PCV13-experienced younger adults.</p><p><strong>Conclusions: </strong>The use of PCV21 in US adults aged 19-64 years with underlying medical conditions can be cost-effective, or cost-saving in most cases, across a wide range of scenarios.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108159"},"PeriodicalIF":4.5000,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"What About Vaccine-Experienced Younger Adults? Cost-Effectiveness of PCV21 Use in Vaccine-Experienced US Adults Aged 19-64 Years with Underlying Medical Conditions.\",\"authors\":\"Zinan Yi, Elamin H Elbasha, Kwame Owusu-Edusei\",\"doi\":\"10.1016/j.amepre.2025.108159\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Because of the residual pneumococcal disease burden among vaccineexperienced adults aged 19-64 years with underlying medical conditions in the United States (US), the Advisory Committee on Immunization Practices (ACIP) recommended revaccination with higher valent pneumococcal conjugate vaccine (PCV). Following PCV21's 2024 introduction, it was added as an option. This study evaluated the cost‑effectiveness of PCV21 versus the recommended alternatives (PPSV23, PCV15, and PCV20) in this population.</p><p><strong>Methods: </strong>A published static multi-cohort state-transition Markov model was used to estimate the lifetime incremental clinical and societal economic outcomes of administering a single dose of PCV21 in adults aged 19-64 years who were previously vaccinated 5 years ago with PPSV23 or PCV13, or 2 years ago with PCV15. The estimated total quality-adjusted life years (QALYs) and costs (in 2023 USD) were discounted at an annual rate of 3%, as well as the incremental cost-effectiveness ratios (ICERs) reported as $/QALY gained. Probabilistic/Deterministic sensitivity analysis (PSA/DSA) and scenario Analysis was conducted.</p><p><strong>Results: </strong>Among 19-49 year-olds, compared with PPSV23, the ICER of PCV21 in the PCV13- and PCV15-experienced adults was $99,700 and $149,300, respectively. PCV21 was cost-saving versus PCV15 in the PPSV23-experienced and versus PCV20 across all vaccine-experienced population. Among 50-64 year-olds, compared with PPSV23, the ICER of PCV21 was $62,400/QALY in PCV13-experienced and $85,400 in PCV15-experienced. PCV21 was cost-saving compared with PCV15 or with PCV20 across all vaccine-experienced population. The DSA identified that discount rates and vaccine effectiveness were the most influential inputs. The PSA confirmed the results' robustness. The scenario analysis showed only minor changes in ICER when the time since last vaccination extended to 8 years for the PPSV23 or PCV13-experienced younger adults.</p><p><strong>Conclusions: </strong>The use of PCV21 in US adults aged 19-64 years with underlying medical conditions can be cost-effective, or cost-saving in most cases, across a wide range of scenarios.</p>\",\"PeriodicalId\":50805,\"journal\":{\"name\":\"American Journal of Preventive Medicine\",\"volume\":\" \",\"pages\":\"108159\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Preventive Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amepre.2025.108159\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Preventive Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amepre.2025.108159","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
What About Vaccine-Experienced Younger Adults? Cost-Effectiveness of PCV21 Use in Vaccine-Experienced US Adults Aged 19-64 Years with Underlying Medical Conditions.
Background: Because of the residual pneumococcal disease burden among vaccineexperienced adults aged 19-64 years with underlying medical conditions in the United States (US), the Advisory Committee on Immunization Practices (ACIP) recommended revaccination with higher valent pneumococcal conjugate vaccine (PCV). Following PCV21's 2024 introduction, it was added as an option. This study evaluated the cost‑effectiveness of PCV21 versus the recommended alternatives (PPSV23, PCV15, and PCV20) in this population.
Methods: A published static multi-cohort state-transition Markov model was used to estimate the lifetime incremental clinical and societal economic outcomes of administering a single dose of PCV21 in adults aged 19-64 years who were previously vaccinated 5 years ago with PPSV23 or PCV13, or 2 years ago with PCV15. The estimated total quality-adjusted life years (QALYs) and costs (in 2023 USD) were discounted at an annual rate of 3%, as well as the incremental cost-effectiveness ratios (ICERs) reported as $/QALY gained. Probabilistic/Deterministic sensitivity analysis (PSA/DSA) and scenario Analysis was conducted.
Results: Among 19-49 year-olds, compared with PPSV23, the ICER of PCV21 in the PCV13- and PCV15-experienced adults was $99,700 and $149,300, respectively. PCV21 was cost-saving versus PCV15 in the PPSV23-experienced and versus PCV20 across all vaccine-experienced population. Among 50-64 year-olds, compared with PPSV23, the ICER of PCV21 was $62,400/QALY in PCV13-experienced and $85,400 in PCV15-experienced. PCV21 was cost-saving compared with PCV15 or with PCV20 across all vaccine-experienced population. The DSA identified that discount rates and vaccine effectiveness were the most influential inputs. The PSA confirmed the results' robustness. The scenario analysis showed only minor changes in ICER when the time since last vaccination extended to 8 years for the PPSV23 or PCV13-experienced younger adults.
Conclusions: The use of PCV21 in US adults aged 19-64 years with underlying medical conditions can be cost-effective, or cost-saving in most cases, across a wide range of scenarios.
期刊介绍：
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.
Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.
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