Abstract
BackgroundThere is currently no data on the age- and risk-group-specific cost-effectiveness of the 13 valent pneumococcal vaccine (PCV13) compared with the 23 valent polysaccharide vaccine (PPV23). The aim of this study was to evaluate the cost-effectiveness of vaccinating these specific groups against pneumococcal disease.MethodsA previously published and independently validated (by The Dutch National Health-Care Institute) age-and risk-group-specific Markov-type model was used to compare the cost-effectiveness of PCV13 vaccination vs. PPV23 vaccination of all adults at increased risk of pneumococcal disease (i.e., adults with underlying disease and those ≥50 years). Efficacy estimates for PCV13 were extrapolated from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Efficacy estimates for PPV23 were based on systematic literature reviews and other published data.ResultsAt list price (€68.56 for PCV13 and €19.99 for PPV23), vaccination of all adults at increased risk of pneumococcal disease resulted in an ICER of €20,186/QALY, while vaccinating those with chronic medical conditions (moderate risk) and immunocompromising conditions (high risk) resulted in an ICER of <€10,000/QALY. Large differences in ICERs between age-and risk-groups were observed(table). Vaccinating, high-risk individuals with PCV13 was cost-saving for those aged less than 65 years of age compared with PPV23 while vaccinating those aged 85 years and older with PCV13 was moderate cost-effective with an ICER of €60,900/QALY. Vaccinating moderate risk individuals was highly cost-effective (<€20,000/QALY), while vaccinating those with low-risk of pneumococcal infection was cost-effective (<€50,000/QALY). However, within risk groups the ICER differed significantly between age groups. Sensitivity analysis showed that a proportional decrease in list price, such as common in national vaccination programs, decreased the ICER disproportionally in favor of PCV13.ConclusionVaccination all adults with PCV13 is cost effective compared with PPV23. There is a large variation in the cost-effectiveness between age and risk groups. Targeting individuals with underlying diseases aged less than 85 years would provide most value for money. Disclosures M. Rozenbaum, Pfizer: Employee and Shareholder, Salary.
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