Cost-effectiveness of use of 20-valent pneumococcal conjugate vaccine among adults in Germany

ABSTRACT

Objectives

Despite national recommendations for use of pneumococcal vaccines, rates of community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) remain high in Germany. New pneumococcal conjugate vaccines (PCVs) with expanded coverage have the potential to reduce the pneumococcal disease burden among adults.

Methods

Using a Markov model, we evaluated the lifetime outcomes/costs comparing 20-valent PCV (PCV20) with standard of care (SC) vaccinations for prevention of CAP and IPD among adults aged ≥60 years and at-risk adults aged 18–59 years in Germany. PCV20 also was compared with sequential vaccination with 15-valent PCV (PCV15) followed by PPSV23 in a scenario analysis.

Results

Over the course of a lifetime (82 years), use of PCV20vs. SC would prevent 54,333 hospitalizations, 26368 outpatient CAP cases, 10946 disease-related deaths yield 74,694 additional life-years (LYs), while lowering total medical costs by 363.2 M €. PCV20 remained cost saving (i.e. dominant) versus SC even in numerous sensitivity analyses, including a sensitivity analysis assuming moderate effectiveness of the SC pneumococcal polysaccharide vaccine against noninvasive pneumococcal CAP. In several scenario analyses and a probabilistic sensitivity analysis, PCV20 was also cost-saving compared toPCV15 PPSV23 vaccination.

Conclusions

One dose of PCV20 among adults aged ≥60 years and adults aged 18–59 years with moderate- and high-risk conditions wouldsubstantially reduce pneumococcal disease, save lives, and be cost saving compared with SC.

KEYWORDS:

• Pneumococcal conjugate vaccine
• cost-effectiveness
• pneumococcal disease
• Germany
• community acquired pneumonia

Article highlights

• Pneumococcal disease causes significant morbidity and mortality among adults in Germany

• New, higher valent vaccines have the potential to reduce disease burden and associated costs in vulnerable populations

• Over a lifetime, 20-valent pneumococcal conjugate vaccine was found to be cost-saving compared with current standard of care for pneumococcal disease prevention among adults in Germany

Declaration of interest

F Kühne, J Friedrich, R Sprenger, C Theilacker, C von Eiff, and J Vietri are employees of Pfizer. Ernestine Mahar was an employee of Pfizer Deutschland GmbH at the time of analysis, but not at the time of publication. All of which may hold stock or stock options. Mark Atwood is an employee of Policy Analysis Inc. (PAI), which received financial support from Pfizer for this study. K Achtert, F Püschner, D Urbanski-Rini, and J Schiller are employees of the Private Institute for Applied Health Services Research (inav), which received financial support from Pfizer for this study. Pfizer is the manufacturer one of the vaccines investigated in this paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium for their review work. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Reiko Sato and Julia Schiffner-Rohe for many valuable discussions and Mark van der Linden for providing IPD data. Further, we would like to thank Ahuva Hanau for medical writing.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14760584.2023.2262575

Additional information

Funding

The research described herein and manuscript development was supported by Pfizer Pharma GmbH and Pfizer Inc.