Abstract
ObjectivesThe Canadian National Advisory Committee on Immunization (NACI) recommends use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in a sequential schedule (PCV13 → PPV23) among adults aged ≥ 65 years and those aged ≥ 18 years who are immunocompromised. In light of recent PCV13 efficacy data from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), and new sero-epidemiology data on community-acquired pneumonia (CAP), we examined the economic implications of funding an expanded adult pneumococcal immunization program in Canada.MethodsA microsimulation model depicting expected lifetime risks, consequences, and costs of invasive pneumococcal disease (IPD) and CAP was developed. PPV23 effectiveness was based on published literature, and PCV13 effectiveness was based on CAPiTA; all other model parameters were based on published data or secondary sources. Herd effects from the PCV13 pediatric program were considered. Outcomes and costs were evaluated assuming use of PPV23 alone, and alternatively, use of PCV13 → PPV23 among (1) all adults aged ≥ 65 years (n = 5.4 M) and (2) immunocompromised and high-risk adults aged ≥ 65 years (n = 3.0 M).ResultsFor population no. 1, PCV13 → PPV23 reduced IPD cases by 1100, CAP cases by 7000, and disease costs by $135.8M; vaccination costs increased by $254.3M, and cost per QALY gained was $35,484. For population no. 2, PCV13 → PPV23 reduced IPD cases by 900, CAP cases by 6000, and disease costs by $120.3M; vaccination costs increased by $149.8M, and cost per QALY gained was $10,728.ConclusionExpanding use of PCV13 → PPV23 by funding PCV13 among Canadian adults aged ≥ 65 would be a cost-effective use of healthcare resources.
Highlights
Streptococcus pneumoniae is the leading cause of bacteremia, meningitis, and bacterial pneumonia in children and adults
Recent advances in diagnostic methods have been used to demonstrate the significant burden of non-bacteremic pneumococcal pneumonia (NBPP) in Canada (McNeil et al 2014a, b), and to demonstrate the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) against NBPP in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) (Bonten et al 2014)
The primary objective of CAPiTA was to evaluate the efficacy of PCV13 against first episode of vaccine-type pneumococcal community-acquired pneumonia (CAP); secondary objectives were to evaluate the efficacy of PCV13 against the first episode of vaccine-type NBPP and the first episode of vaccine-type Invasive pneumococcal disease (IPD)
Summary
Streptococcus pneumoniae (pneumococcus) is the leading cause of bacteremia, meningitis, and bacterial pneumonia in children and adults. Invasive pneumococcal disease (IPD)—including bacteremia and meningitis—is most common in the very young, the elderly, and specific risk groups, such as immunocompetent persons with chronic diseases (high risk) and those with immunocompromising conditions. Pneumococcal community-acquired pneumonia (CAP) can be both invasive and non-invasive; noninvasive/non-bacteremic pneumococcal pneumonia (NBPP) is more common but is difficult to diagnose. Recent advances in diagnostic methods have been used to demonstrate the significant burden of NBPP in Canada (McNeil et al 2014a, b), and to demonstrate the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) against NBPP in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) (Bonten et al 2014). The primary objective of CAPiTA was to evaluate the efficacy of PCV13 against first episode of vaccine-type pneumococcal CAP; secondary objectives were to evaluate the efficacy of PCV13 against the first episode of vaccine-type NBPP and the first episode of vaccine-type IPD
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