Abstract
Background Streptococcus pneumoniae causes significant morbidity and mortality among adults, especially among the elderly and those with underlying medical conditions. To reduce the disease burden the Health Council of the Netherlands recently recommended that people aged 60 and over should be offered vaccination against pneumococcal infections with the vaccine 23 valent polysaccharide vaccine (PPV23). This study aimed to evaluate the cost-effectiveness vaccinating people aged 60 with PPV23 compared with sequential vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) followed by vaccination with PPV23.MethodsA previously published microsimulation model was used to compare the cost-effectiveness of PPV23 vaccination vs. sequential PCV13-PPV23 vaccination by age and risk group. PPV23 effectiveness was based on published literature, PCV13 effectiveness was based on CAPiTA; all other model parameters were based on published data. Outcomes and costs were evaluated assuming use of PPV23 alone, and alternatively, use of PCV13 → PPV23 among all adults aged 60 years and those at with chronic medical conditions (moderate risk) and immunocompromising conditions (high risk) aged 60 years.ResultsVaccinating individuals aged 60 years with PCV13 followed by vaccination with PPV23 would prevent 215 cases of IPD, 360 cases of hospitalized pneumonia, and 2,200 cases of outpatient pneumonia cases per vaccinated cohort compared with vaccination with PPV23 alone. At list price (€68.56 for PCV13 and €19.99 for PPV23) the ICER of vaccinating all adults of 60 years of age resulted in an ICER of €5,000/QALY. Adding a single dose of PCV13 for those with chronic medical conditions (moderate risk) and immunocompromising conditions (high risk) was shown to be cost saving compared with vaccination with PPV23 alone. Sensitivity analysis showed that a proportional decrease in list price decreased the ICER disproportionally in favor of adding a single dose of PCV13.ConclusionExpanding the recommendation of only PPV23 to PCV13→PPV23 among Dutch adults aged 60 years and older is a cost-effective use of healthcare resources. In particular adding a single dose of PCV13 for those with moderate or high risk of pneumococcal disease was shown to be cost-saving.Disclosures M. Rozenbaum, Pfizer: Employee and Shareholder, Salary.
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