Cost-effectiveness of pneumococcal vaccines among adults over 50 years old in low- and middle-income countries: a systematic review

ABSTRACT

Introduction

This systematic review aims to provide a critical summary of economic evaluations of pneumococcal vaccines for adults aged 50 years or older in low- and middle-income countries (LMICs): a 23-valent polysaccharide vaccine (PPSV23), and a 13-valent conjugated vaccine (PCV13).

Areas covered

We systematically searched for studies published until October2020 in PubMed and Web of Science. Searching strategies in this literature review were done using various combinations of terms related to ‘economic evaluation or cost-effectiveness or cost-benefit or cost-utility,’ ‘pneumococcal or PPSV or PCV or PPV,’ and ‘vaccine or vaccination or immunization’ in all fields. To be included, each study had to meet our inclusion criteria. Two authors reviewed and extracted studies. From 1,711 records, we included 18 studies for this review. All 18 studies were cost-effectiveness analysis. Compared with no vaccination, either PPSV23 or PCV13 was economically favorable, highly cost-effective, and in many cases, cost-saving for older adults. Studies compared one vaccination (PPSV23 or PCV13) over another and had different findings.

Expert opinion

While all studies recommended either PPSV23 or PCV13 for older adults in LMICs, substantial questions about potential bias in studies and whether conclusions hold after including the impact of indirect protection.

KEYWORDS:

• Systematic review
• pneumococcal vaccine
• cost-effectiveness analysis
• low- and middle-income countries
• vaccination

Article Highlights

• A systematic collection of economic evaluations of adult pneumococcal vaccination strategies in low- and middle-income countries is presented.

• Studies are contrasted by economic finding, funding source, and key input parameters.

• Most studies are funded by vaccine manufacturers which find pneumococcal vaccines to be cost-saving.

• Independently funded studies find vaccines to be only cost-effective by various thresholds.

No independent studies have incorporated indirect effects from the childhood program.

Acknowledgments

The authors would like to thank participants in the World Health Organization’s Strategic Advisory Group of Experts (SAGE) pneumococcal working group for invaluable feedback on the development of this study.

Author Contributions

All authors contributed to study development, data extraction, draft writing, and critical review of the paper for important intellectual content. All authors are in agreement with the content of the final article and have approved it for submission and publication.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.