PIN32 - A Sistematic Review Of The Cost-Effectiveness Of Vaccinating Elderly With The 23-Valent Pneumococcal Polysaccharide Vaccine (Ppv23)

Abstract

To systematically review the available literature on cost-effectiveness of PPV23 in adults aged >60 years. We searched the MEDLINE, LILACS, Bireme, Cochrane, EMBASE, NHSEDD and Centre for Reviews and Dissemination (CRD) databases for full economic evaluations of PPV23 published up to March 2016. Two independent reviewers screened the articles for relevance and extracted the data. Main study characteristics and methods (clinical and epidemiological data, cost and incremental cost-effectiveness ratios (ICERs) were extracted and compared. Costs were updated to US$2016. Twenty-seven studies were reviewed. The studies were published from 1980 to 2016. Most were conducted in Europe and US (81.5%); three studies were conducted in Latin America (Brazil, 2; Colombia, 1). All studies compared VPP23 to not-vaccinating and three studies also compared VPP23 to pneumococcal conjugate 13-valent vaccine (PCV13). All studies used static models. Most use a lifetime (44.4%) or 5 to 6 year’s time horizon (33.3%). Just 3 studies considered herd protection from children immunization with PCV13 in the model. Most studies considered PCV23 cost-effective (less than US$50,000 per LYG or QALY) and sometimes cost-saving (results ranging from cost-saving to 101,670/QALY). This systematic review revealed that the cost-effectiveness results have conflicting results, from cost-saving to not cost-effective at all. Assumptions regarding vaccine effectiveness, particularly for non-invasive pneumonia, and waning immunity varies greatly among different studies and impact the results.