A review of economic evaluations of 13-valent pneumococcal conjugate vaccine (PCV13) in adults and the elderly

Figures & data

Table 1. Summary information from the identified studies

Author/Country	Model used	Age group targeted (y)	Primary outcome	Time Horizon	Discounting rate	Potential conflict of interest
Smith et al. ^24/US	Markov model	>65 and >75	QALY^a	Lifetime	3% both costs and outcomes	No conflict of interest reported
Weycker et al. ^25/US	Markov-type model (micro simulation)	≥50	LYG^b	Lifetime	3% both costs and outcomes	Funded by Pfizer
Smith et al. ^26/US	Markov model	19–49, 50–59, 60–69, 70–79, 80+	QALY^a	15 y	3% both costs and outcomes	Two of authors had research grant/s from Merck
Smith et al. ^27/US	Markov model	≥50	QALY^a	Lifetime	3% both costs and outcomes	Two of authors had research grant/s from Merck
Cho et al. ^28/US	Markov-type model	≥19 (19–64 and ≥65 )	QALY^a	Lifetime	3% both costs and outcomes	No conflict of interest reported
Boccalini et al. ^29/Italy	Markov-type model	≥65 , ≥70 , ≥75^c	QALY^a, LYG^b	5 y	3% only to costs but not outcomes	One author had grant from Pfizer
Liguori et al. ^30/Italy	Markov-type model	50–79, 50–64 and 65	Case prevented	5 y	3% only to costs but not outcomes	One author had grant from Pfizer
Rozenbaum et al. ^32/Netherlands	Decision-tree analytic	≥65	QALY^a	5 y	Cost 4% and health outcome 1.5%	Funded by Wyeth pharmaceutical
Rozenbaum et al. ^31/England	Markov-based model	2<group<65 and ≥65	QALY^a	Lifetime	3% both costs and outcomes	No conflict of interest reported
Pradas et al.^33 /Spain	Dynamic transmission model (SIS^d)	≥65	Case prevented	5 y	3% only to costs but not outcomes	Funded by Pfizer and 2 authors employee of Pfizer

^aQALY: quality adjusted life years.

^bLYG: life years gained.

^cSingle, double (simultaneous vaccination of ≥65 and ≥70 ) and triple (simultaneous vaccination of ≥65 and ≥70 and ≥75 ) cohort were considered in this study.

^dSIS: Susceptible-Infected-Susceptible (recovery).

Table 2. Summary of vaccination and healthcare costs in the studies^j,k

				Vaccination cost		IPD^a hospitalization	Non-invasive
Author/Country	Currency base	Perspective	Administration cost	PPV23	PCV13	cost	hospitalization cost
Smith et al. ^24/US	2006 US $	Societal	Not reported	$43^b	$128^b	$20,416	$16,925
Weycker et al. ^25/US	2010 US $	Societal and Health care provider	$17	$49	$108	$26,434 $32,795^d	$15,564
Smith et al. ^26/US	2006 US $	Societal	Not reported	$43^b	$128^b	$20,416	$16,925
Smith et al. ^27/US	2006 US $	Societal	Not reported	$43^b	$128^b	$20,416	$16,925
Cho et al. ^28/US	2009 US $	Societal	$25	$55.02	$124.37	$25,702-$79,193^e	$18,380-$26,526^e
Boccalini et al. ^29/Italy	2012 €	Health care provider	Not reported	€16 ($20.8)	€42.5 ($55.25)	€4068^f-€19,114^d ($5288.4^f-$24848^d)	€2680.85 ($3485.1)
Liguori et al. ^30/Italy	Not reported	Health care provider	NA	Not reported	€42.5 ($55.25)	€3809 ($4951.7)	€3809 ($4951.7)
Rozenbaum et al. ^32/Netherlands	2010 €	Societal	Not reported	Not reported	€50 ($65)	€7105^g, -€15,255^d ($9236.5^g-$19,831.5^d)	€5194 ($6752.2)
Rozenbaum et al. ^31/England	2012 £	Health care provider	£7.51 ($12.01)	Not reported	£56.61 ($90.576)	£825^h-£8977^i ($1320^h-$14,363^i)	£661 ($1057.6)
Pradas et al.^33 /Spain	2010 €	Health care provider	Not reported	Not reported	€49.91 ($64.88) (ex-factory )	€4093^c-€11,202^d ($5320.9^c-$14,562^d)	€1983 ($2577.9)

^aIPD: Invasive pneumococcal disease.

^bInclusive administration cost.

^cCost of bacteremia.

^dCost of meningitis.

^eThe range for hospitalization among different immunocompromised conditions.

^fCost of bacteremic pneumococcal pneumonia.

^gCost of pneumococcal bacteremia with a focus.

^hCost of short hospital stay.

ⁱCost of long hospital stay.

^jAll currencies were converted to US dollar based on €1=$1.3 and £1=$1.6.

^kHealthcare costs are in the groups targeted as shown in Table 1.

Table 3. Summary of estimated efficacy of PPV23 and PCV13 in the studies

	PPV23		PCV13
Author/Country	IPD	NPP	IPD	NPP	Age group	Source
Smith et al. ^24/US	80%	0%	85%	64%	65^a	Expert panel (Delphi)
Weycker et al. ^25/US	77%	0%	85%	24%^b (for outpatient 6% )	65–74^a	Expert panel (Delphi) for IPD, literature and assumption for NPP
Smith et al. ^26/US	Proportion of PCV13 effectiveness	0%	50%	35%^c	19–49,50–59, 60–69, 70–79, >80^c	Expert panel (Delphi)
Smith et al. ^27/US	80%	0%	85%	64%	65^a	Expert panel (Delphi)
Cho et al. ^28/US	8–25%^d	0%	25% or 75% (in different groups)	0% or 13% (in different groups)	≥19 (19–64 and ≥65 )^c	Literature/assumptions
Boccalini et al. ^29/Italy	70%	0%	94%(meningitis) 87.5% (other IPD)	87.50%^e	≥65 , ≥70 ^a	Literature
Liguori et al. ^30/Italy	NA	NA	87.50%^e	87.50%^e	50–79, 50–64 and65^a	Literature
Rozenbaum et al. ^32/Netherlands	NA	NA	30–90%^f	30–90%^f	≥65 ^a	Literature/assumptions
Rozenbaum et al. ^31/ England	NA	NA	63% (43% immunocompromised)	Not included (base-case)	≥65 ^a	Expert panel
Pradas et al. ^33/Spain	NA	NA	58%^e	58%^e (includes outpatient cases)	≥65 ^a	Assumption

^aGeneral population.

^bEfficacy expressed against all-cause non-invasive pneumonia.

^cImmunocompromised.

^d25% for HIV and end stage renal disease, 8% for organ transplant and hematologic cancer.

^e87.5% against all hospitalized CAP (invasive or non-invasive).

^fIn the base case the efficacy was studied as a range varying between 30–90% in each group.

Table 4. The incidence rate of IPD and NPP in the studies (rate per 100,000)

Author/Country	Age group	IPD^a	NPP^b (hospitalization)	Comments
Smith et al. ^24/US	65–80+	25.9–60.1	567^c	30% of all-cause CAP is pneumococcal
Weycker et al. ^25/US	65–75	18	491	-
Smith et al. ^26/US	60–69	58.52	868^c	30% of all-cause CAP is pneumococcal
Smith et al. ^27/US	60–69	25.9	567^c	30% of all-cause CAP is pneumococcal
Cho et al. ^28/US	≥65	6.8–550.6^d	160–10330^e	-
Boccalini et al. ^29/Italy	65–74	9.5	42.2^f	39.8% of all-cause CAP is pneumococcal
Liguori et al. ^30/Italy	50–79	Expressed as total number/s	Expressed as total number/s	40% of all-cause CAP is pneumococcal
Rozenbaum et al. ^32/Netherlands	65–69	47.4^g	89	35% of all-cause CAP is pneumococcal
Rozenbaum et al. ^31/England	≥65	43.5 (high risk group)	1210 (includes outpatient)	42% of all-cause CAP is pneumococcal
Pradas et al. ^33/Spain	>50	29.7	318.7	50% of all-cause CAP is pneumococcal

^aIPD: Invasive pneumococcal disease.

^bNPP: Non-bactaeremic pneumococcal pneumonia.

^cIn all studies by Smith et al. the age group for NPP hospitalization was ≥65.

^dPCV13 serotype IPD rate 6.8–80.1 and PPV23 serotype IPD rate 43.8–550.6 dependent on immunosuppression condition.

^eNPP rate 160–10330 dependent on immunosuppression condition.

^fCalculated based on rate of non-invasive CAP, 31.8% of CAP hospitalized, and 39% of all cause CAP being pneumococcal.

^gCalculated based on addition of rates of different IPD cases.

Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK., Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in US older adults. Am J Prev Med 2013; 44 4:373-81; PMID:23498103; http://dx.doi.org/10.1016/j.amepre.2012.11.035

 PubMed Web of Science ®Google Scholar

Weycker D., Sato R, Strutton D, Edelsberg J, Atwood M, Jackson LA., Public health and economic impact of 13-valent pneumococcal conjugate vaccine in US adults aged ≥50 years. Vaccine 2012; 30 36:5437-44; PMID:22728289; http://dx.doi.org/10.1016/j.vaccine.2012.05.076

 PubMed Web of Science ®Google Scholar

Smith KJ, Nowalk MP, Raymund M, Zimmerman RK. Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults. Vaccine 2013; 31 37:3950-6; PMID:23806240; http://dx.doi.org/10.1016/j.vaccine.2013.06.037

 PubMed Web of Science ®Google Scholar

Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK. Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. JAMA 2012; 307 8:804-12; PMID:22357831; http://dx.doi.org/10.1001/jama.2012.169

 PubMed Web of Science ®Google Scholar

Cho BH, Stoecker C, Link, Gelles R, Moore MR. Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions. Vaccine 2013; 31 50:6011-21; PMID:24148572; http://dx.doi.org/10.1016/j.vaccine.2013.10.024

 PubMed Web of Science ®Google Scholar

Boccalini S, Bechini A, Levi M, Tiscione E, Gasparini R, Bonanni P. Cost-effectiveness of new adult pneumococcal vaccination strategies in italy. Hum Vaccin Immunother 2013; 9 3:699-706; PMID:23295824; http://dx.doi.org/10.4161/hv.23268

 PubMed Web of Science ®Google Scholar

Liguori, G, Parlato A2, Zamparelli AS3, Belfiore P1, Gallé F1, Di Onofrio V1, Riganti C4, Zamparelli B5. Società Italiana di Health Horizon Scanning (SIHHS). Adult immunization with 13-valent pneumococcal vaccine in campania region, south italy: an economic evaluation. Hum Vaccin Immunother 2014; 10 2:492-7; PMID:24185467; http://dx.doi.org/10.4161/hv.26888

 PubMed Web of Science ®Google Scholar

Rozenbaum MH, Hak E, van der Werf TS, Postma MJ. Results of a cohort model analysis of the cost-effectiveness of routine immunization with 13-valent pneumococcal conjugate vaccine of those aged ≥65 years in the netherlands. Clin Ther 2010; 32 8:1517-32; PMID:20728764; http://dx.doi.org/10.1016/j.clinthera.2010.06.016

 PubMed Web of Science ®Google Scholar

Rozenbaum, MH, van Hoek AJ, Fleming D, Trotter CL, Miller E, Edmunds WJ. Vaccination of risk groups in england using the 13 valent pneumococcal conjugate vaccine: economic analysis. BMJ 2012; 345 7882: PMID:23103369; 10.1136/bmj.e6879

 PubMedGoogle Scholar

Pradas R, Gil de Miguel A, Álvaro A, Gil, Prieto R, Lorente R, Méndez C, Guijarro P, Antoñanzas F., Budget impact analysis of a pneumococcal vaccination programme in the 65-year-old spanish cohort using a dynamic model. BMC Infect Dis 2013; 13 1:175; PMID:23578307; http://dx.doi.org/10.1186/1471-2334-13-175

 PubMedGoogle Scholar