https://orcid.org/0000-0002-6847-1736
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Abstract
Background
A new 20-valent pneumococcal conjugate vaccine (PCV20) provides protection against 20 pneumococcal serotypes. The vaccine has the potential to decrease the impact of pneumococcal diseases in society and to increase health among vulnerable persons.
Aim
This study investigates the cost-effectiveness of vaccinating Danish adults in different age groups and risk of pneumococcal disease with PCV20 compared to the 23-valent pneumococcal polysaccharide vaccine (PPV23) – either as PCV20 compared to PPV23 or as PPV23 followed by PCV20 compared to PPV23.
Methods
A Markov model adapted to the Danish setting was developed to estimate clinical outcomes and costs of vaccinating the Danish population in specific age and risk groups. The model used a restricted societal perspective and estimated outcomes and costs using a lifetime time horizon. To estimate the clinical outcomes and costs, inputs on vaccine effectiveness and waning were retrieved from other studies whereas data on risk groups, coverage and costs were based on real-world data.
Results
The results showed that in all scenarios the incidence and mortality of pneumococcal disease were reduced when vaccinating with PCV20, resulting in lower costs. For the vaccine target group of adults aged ≥18 years at moderate or high risk and all adults aged ≥65 years both in the case of PPV23+PCV20 compared to PPV23 and in case of PCV20 compared to PPV23 vaccination with PCV20 was found to be a dominant strategy gaining 1,350 or 5,821 quality-adjusted life years (QALYs), respectively, and reducing total costs by 60 or 396 million EUR, respectively, as compared to PPV23 vaccination alone. Similar results of dominant PCV20 strategy were found for other age and risk group comparisons. Both deterministic and probabilistic sensitivity analyses confirmed the results being robust to changes in input parameters and applied assumptions.
Limitations
Like other modelling studies, this analysis has limitations such as lack of detailed data for some inputs.
Conclusion
Vaccination with PCV20 reduced the incidence and mortality of pneumococcal diseases in Danish adults compared to PPV23. This reduction has the potential to reduce the financial burden related to managing diseases while also increasing public health.
Transparency
Declaration of funding
This research was funded by Pfizer Denmark ApS.
Declaration of interest of financial/other interests
MS and PBP are employees at Pfizer Denmark. JV is an employee at Pfizer Inc. MS, JV and PBP own shares in Pfizer Inc. outside submitted work. JO, MBM and HS are employees at Incentive Denmark Aps, which was a paid vendor to Pfizer Denmark on the project. Pfizer is a manufacturer of vaccines.
Author contributions
All authors have made a significant contribution to the work and meet the criteria for authorship. MS, JV and PBP have been included in the conception and design of the study and have revised the manuscript critically for intellectual content. JO, MBM and HS were responsible for the model development and have analyzed and interpreted the data and drafted the manuscript. All authors have approved the final version and are accountable for all aspects of this work.
Acknowledgements
No assistance in the preparation of this article is to be declared.
Data availability statement
All input data used in the model are publicly available or can be retrieved from the Danish National Patient Register, the Danish Cause of Death Register, and other publicly available sources. The model will not be shared.
Reviewer disclosures
Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.