Cost-utility of 20-valent pneumococcal conjugate vaccine compared to no vaccination and recommended alternative vaccines among Belgian adults

ABSTRACT

Background

The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population.

Research Design and Methods

The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives.

Results

Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65–84 years would also be cost-saving from the national healthcare perspective.

Conclusion

Based on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost.

Plain Language Summary

Pneumococcal infections cause a high burden on infected patients and society. Vaccination of patients at risk of severe infection has been recommended for decades, but uptake of pneumococcal vaccines in adults has historically been low in Belgium, where patients have borne the vaccine costs and the recommended vaccination schedule required the sequential administration of two vaccines. A single PCV20 dose is recommended as the preferred vaccine for adults at risk due to age or other factors in Belgium as it is expected to provide lasting protection against more types of disease-causing pneumococcal bacteria as well as being simpler to administer than alternatives requiring multiple injections. Uptake is expected to improve with the recent reimbursement of the new PCV20 vaccine, though reimbursement covers only a portion of the recommended population. This paper presents a detailed analysis of the PCV20 cost-effectiveness in all adults at increased risk of severe pneumococcal disease, including immunocompromised adults younger than 65 years. Our analysis captures and compares the lifetime risk of pneumococcal disease and associated healthcare costs in an unvaccinated cohort, a cohort vaccinated with the alternative recommendation of PCV15 and PPV23 vaccines and a cohort vaccinated with PCV20. This cost-effectiveness analysis indicates that use of PCV20 will help decrease the number of pneumococcal disease cases, hospitalizations, and premature deaths at an affordable healthcare cost: PCV20 is a cost-effective option compared to no vaccination and a cost-saving option compared to the sequential regimen PCV15 followed by PPV23 in the Belgian adult population recommended for pneumococcal vaccination.

KEYWORDS:

• Pneumococcal vaccination
• PCV20
• cost-effectiveness
• cost-utility
• adults

Declaration of interests

A Mignon, A Taelman, and J Vietri are employees of Pfizer and own stock of Pfizer Inc. S Marbaix is an external consultant who has received consulting fees from Pfizer in connection with the development of this study and manuscript. A Averin and M Atwood are employees of PAI, which was a paid consultant to Pfizer in connection with the development of this study. 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 materials 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.

Author contributions

All authors have 1) substantially contributed to the conception, study design, execution, acquisition of data, analysis, and/or interpretation 2) have been involved in writing or substantially revised or critically reviewed the article 3) have agreed on the journal to which the article has been submitted 4) reviewed and agreed on all versions of the article before submission, during revision and the final version accepted for publication 5) agree to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Acknowledgments

The following Belgian experts have provided recommendations on inputs of this analysis during a meeting on 30 March 2022 and/or 15 June 2022 : Dr. Pascal Van Bleyenbergh (Lung Disease, University Hospital Leuven), Prof. Dr. Emeritus Willy Peetermans (Internal Medicine, University Hospital Leuven), Prof. Dr. Bernard Vandercam (Infectious Diseases, University Hospital St Luc, Brussels), Prof. Dr. Bert Vaes (Primary Care, Catholic University Leuven) and Dr. Germaine Hanquet (Epidemiology, Consultant).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14760584.2023.2273892.

Additional information

Funding

This study was funded by Pfizer, Inc. Funding included the model development, the customization to Belgian context and the medical writing.