Cost–effectiveness of vaccinating the elderly and at-risk adults with the 23-valent pneumococcal polysaccharide vaccine or 13-valent pneumococcal conjugate vaccine in the UK

Abstract

Objective: The introduction of routine childhood vaccination with pneumococcal conjugate vaccines (PCVs) has led to a decrease in the overall incidence of pneumococcal disease in all ages and a change in the serotype distribution of the remaining disease. This study assessed the cost–effectiveness of vaccinating ≥65 years and at risk adults with either the 23-valent pneumococcal polysaccharide vaccine (PPV23) or the 13-valent conjugate vaccine (PCV13) in the UK, accounting for epidemiological changes. Methods: A population-based Markov model was used to track one UK-based cohort of individuals assuming PPV23, PCV13 or no vaccination until death. Results: The ICER was estimated at £8413 when PPV23 was compared to no vaccination. PPV23 dominated PCV13. Conclusion: This model suggests that vaccinating with PPV23 is cost-effective when compared to both PCV13 and no vaccination. As PPV23 covers 80–90% in the UK of all serotypes causing invasive pneumococcal diseases, it remains cost-effective despite recent reductions in invasive pneumococcal diseases incidence in adults.

Keywords::

• cost–effectiveness analysis
• epidemiological change
• invasive pneumococcal diseases
• pneumococcal conjugate vaccine
• pneumococcal polysaccharide vaccine

Financial & competing interests disclosure

This study was conducted by Amaris and funded by Sanofi Pasteur MSD.Y Jiang & A Gauthier are employees of Amaris. S Keeping & S Carroll are employees of Sanofi Pasteur MSD. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Invasive disease caused by Streptococcus pneumoniae infection can be life-threatening.

• In children, the routine vaccination program against pneumococcal diseases with PCV led to a decrease in the incidence of invasive pneumococcal diseases (IPD) associated with serotypes covered by the vaccine not only in children but also in unvaccinated adults. However, an increase was seen in the incidence of IPD associated with serotypes not covered by PCV in adults.

• In spite of the epidemiological change, vaccinating the at-risk adults and the elderly with 23-valent PPV is still cost-effective compared with no vaccination or 13-valent PCV due to its broad serotype coverage.

• The model should be updated with new data on the dynamics of IPD and nonbacteremic pneumococcal pneumonia, cost of managing pneumococcal diseases and comparative vaccine efficacy when available.

Notes