Evaluating the cost-effectiveness of a sequential pneumococcal vaccination compared to single-dose vaccination strategy for adults in Hong Kong

Figures & data

Table 1. Clinical outcomes of sequential model for adults aged 20–64 years with immunocompromised and chronic conditions.

Number of cases	PPSV23	PCV13→PPSV23	Difference
			(PCV13→PPSV23 – PPSV23)
Bacteremia
20–49	2,096	2,087	−9
50–64	925	905	−20
Total	3,021	2,992	−29
Meningitis
20–49	362	362	0
50–64	180	173	−7
Total	542	535	−7
Inpatient pneumonia
20–49	2,656,738	2,656,225	−513
50–64	1,355,408	1,353,136	−2,272
Total	4,012,146	4,009,361	−2,785
Outpatient pneumonia
20–49	4,373,409	4,370,969	−2,429
50–64	1,935,942	1,930,371	−5,571
Total	6,309,351	6,301,340	−8,000
Deaths due to disease
20–49	402,989	402,969	−20
50–64	215,737	215,508	−229
Total	618,726	618,477	−249

Table 2. Clinical outcomes of sequential model for adults age ≥65 years.

Number of cases	PPSV23	PCV13→PPSV23	Difference
			(PCV13→PPSV23 – PPSV23)
Bacteremia
65–74	226	203	−23
75–84	88	76	−12
85+	16	14	−2
Total	330	293	−37
Meningitis
65–74	30	26	−4
75–84	4	3	−1
85+	-	-	-
Total	34	29	−5
Inpatient pneumonia
65–74	404,264	401,170	−3,094
75–84	226,668	224,565	−2,103
85+	80,470	79,770	−700
Total	711,402	705,505	−5,897
Outpatient pneumonia
65–74	467,152	462,258	−4,894
75–84	188,882	186,807	−2,075
85+	45,047	44,660	−387
Total	701,081	693,725	−7,356
Deaths due to disease
65–74	68,617	68,208	−409
75–84	42,543	42,213	−330
85+	17,920	17,780	−140
Total	129,080	128,201	−879

Table 3. Economic outcomes of sequential model for adults aged 20–64 years with immunocompromised and chronic conditions.

Costs ($, in thousands)	PPSV23	PCV13→PPSV23	Difference (PCV13→PPSV23 – PPSV23)
Direct medical costs
20–49	7,359,066	7,353,456	−5,610
50–64	7,299,109	7,277,106	−22,003
Total	14,658,175	14,630,562	−27,613
Vaccination costs
20–49	-	15,528	15,528
50–64	-	11,891	11,891
Total	–	27,419	27,419
Indirect costs
20–49	1,182,859	1,181,963	−896
50–64	1,252,655	1,249,141	−3,514
Total	2,435,514	2,431,104	−4,410
Total costs
20–49	8,541,925	8,550,947	9,022
50–64	8,551,764	8,538,138	−13,626
Total	17,093,689	17,089,085	−4,604

Table 4. Economic outcomes of sequential model for adults age ≥65 years.

Costs ($, in thousands)	PPSV23	PCV13→PPSV23	Difference (PCV13→PPSV23 – PPSV23)
Direct medical costs
65–74	2,845,440	2,816,657	−28,783
75–84	1,827,812	1,807,858	−19,954
85+	666,322	659,985	−6,337
Total	5,339,574	5,284,500	−55,074
Vaccination costs
65–74	2,086	10,209	7,403
75–84	2,029	7,183	5,155
85+	875	3,099	2,224
Total	4,990	20,491	14,782
Indirect costs
65–74	490,441	485,932	−4,508
75–84	274,507	272,239	−2,269
85+	65,912	65,750	−161
Total	830,860	823,921	−6,938
Total costs
65–74	3,338,687	3,312,799	−25,888
75–84	2,104,348	3,087,280	−17,068
85+	733,109	728,834	−4,274
Total	6,176,144	7,128,913	−47,230

Table 5. Base-case cost-effective analysis.

Per-patient results	PPSV23	PCV13→PPSV23
Life years
20–49	20.59211	20.59233
50–64	14.86675	14.86957
65–74	10.20584	10.22082
75–84	6.23467	6.25503
85+	3.4158	3.43185
QALYs
20–49	16.48884	16.489
50–64	10.64566	10.64749
65–74	6.84887	6.85794
75–84	3.75682	3.76813
85+	1.62077	1.62852
Incremental cost per life-year gained (USD)
20–49	-	12,621
50–64	-	Dominant
65–74	-	Dominant
75–84	-	Dominant
85+	-	Dominant
Incremental cost per QALY gained (USD)
20–49	-	16,700
50–64	-	Dominant
65–74	-	Dominant
75–84	-	Dominant
85+	-	Dominant

Table 6. Incremental cost-effective analysis stratified by age and risk group.

Age group	Healthy individuals	Chronic conditions	Immunocompromised	All risk groups
Incremental cost per life-year gained (USD)
20–49	96,616	21,833	Dominant	12,261
50–64	763	Dominant	Dominant	Dominant
65–74	Dominant	Dominant	Dominant	Dominant
75–84	Dominant	Dominant	Dominant	Dominant
85+	Dominant	Dominant	Dominant	Dominant
Incremental cost per QALY gained (USD)
20–49	125,126	26,677	Dominant	16,700
50–64	1,149	Dominant	Dominant	Dominant
65–74	Dominant	Dominant	Dominant	Dominant
75–84	Dominant	Dominant	Dominant	Dominant
85+	Dominant	Dominant	Dominant	Dominant

*High risk: chronic conditions and immunocompromised.

Figure 1. One-way deterministic sensitivity analysis – Tornado diagram.

*Costs include direct medical cost, indirect cost and vaccination costs in USD.