Cost-effectiveness of using a 20-valent pneumococcal conjugate vaccine to directly protect adults in England at elevated risk of pneumococcal disease

ABSTRACT

Objectives

Despite the current pneumococcal vaccination program in England for older adults and adults with underlying conditions, disease burden remains high. We evaluated cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to current pneumococcal recommendations for adults in England.

Methods

Lifetime outcomes/costs of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) among adults aged 65–99 years and adults aged 18–64 years with underlying conditions in England were projected using a deterministic cohort model. Vaccination with PCV20 was compared with 23-valent pneumococcal polysaccharide vaccine (PPV23) from the National Health Service perspective.

Results

PCV20 was cost saving compared with PPV23 in base case and most sensitivity analyses. In the base case, replacing PPV23 with PCV20 prevented 7,789 and 140,046 cases of IPD and hospitalized CAP, respectively, and 22,199 associated deaths, resulting in incremental gain of 91,375 quality-adjusted life-years (QALYs) and incremental savings of £160M. In probabilistic sensitivity analyses, PCV20 (vs. PPV23) was cost saving in 85% of simulations; incremental cost per QALY was below £30,000 in 99% of simulations.

Conclusions

PCV20 vaccination in adults aged 65–99 years and those aged 18–64 years with underlying comorbidities in England is expected to prevent more hospitalizations, save more lives, and yield lower overall costs than current recommendations for PPV23.

KEYWORDS:

• Streptococcus pneumoniae
• vaccination
• immunization
• cost-effectiveness
• pneumococcal conjugate vaccine

Declaration of interest

The research described herein and manuscript development was supported by Pfizer Inc. D Mendes, R Sato, A Vyse, J Campling, G Ellsbury, and T Mugwagwa are employees and shareholders of Pfizer; no other relationships or activities that could appear to have influenced the submitted work. M Slack has received personal fees from GSK, Pfizer, Merck, AstraZeneca and Sanofi Pasteur as a speaker at international meetings and as a member of advisory boards (outside the scope of the submitted work). M Slack has also worked as a contractor for Pfizer and received remuneration from Pfizer. M Atwood, A Averin, and D Weycker are employees of Policy Analysis Inc. (PAI), which received financial support from Pfizer Inc. for this study (including manuscript preparation). 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 no relevant financial or other relationships to disclose.

Author contributions

Authorship was designated based on guidelines promulgated by the International Committee of Medical Journal Editors (2004). All persons who met criteria for authorship were included in the author list. The contribution of each of these persons to this study is as follows: (1) conception and design (all authors), acquisition of data (A Averin, D Mendes, A Vyse, T Mugwagwa), analysis or interpretation of data (all authors); and (2) preparation of manuscript (all authors), critical review of manuscript (all authors). All authors have read and approved the final version of the manuscript. The study sponsor, Pfizer Inc., reviewed the study research plan and study manuscript; data management, processing, and analyses were conducted by PAI. All final analytic decisions and the decision to submit for publication were made solely by study investigators.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2022.2134120

Additional information

Funding

This study was funded by Pfizer Inc.