An intervention to improve pneumococcal vaccination uptake in high risk 50-64 year olds vs. expanded age-based recommendations: an exploratory cost-effectiveness analysis.
Angela R Wateska, Mary Patricia Nowalk, Chyongchiou J Lin, Lee H Harrison, William Schaffner, Richard K Zimmerman, Kenneth J Smith
Author Information
Angela R Wateska: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA. ORCID
Mary Patricia Nowalk: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
Chyongchiou J Lin: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
Lee H Harrison: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
William Schaffner: b Department of Health Policy , Vanderbilt University School of Medicine , Nashville , TN , USA. ORCID
Richard K Zimmerman: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
Kenneth J Smith: a Departments of Medicine and Family Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
In the U.S., pneumococcal polysaccharide vaccine (PPSV23) uptake among high-risk adults aged <65 years is consistently low and improvement is needed. One barrier to improved vaccine coverage is the complexity of the adult vaccination schedule. This exploratory analysis compared the cost-effectiveness of strategies to increase pneumococcal vaccine uptake in high-risk adults aged 50-64 years. We used a Markov model to compare strategies for non-immunocompromised 50-64 year olds: 1) current pneumococcal polysaccharide vaccine (PPSV23) recommendations; 2) current recommendations enhanced by an intervention; 3) PPSV23 plus pneumococcal conjugate vaccine (PCV13) for high-risk patients with no intervention; or 4) both vaccines for all 50-year-olds with no intervention. Parameters included CDC data and other US data, varied extensively in sensitivity analyses. In the analysis, vaccinating high-risk individuals with PPSV23/PCV13 was the least costly strategy, with total costs of $424/person. Vaccinating all 50 year olds with PPSV23/PCV13 cost $40 more and gained 0.00068 quality-adjusted life years (QALY), or $57,786/QALY gained. Current recommendations with or without an intervention program were more expensive and less effective than other strategies. In multi-way sensitivity analyses, the current recommendations/intervention program strategy was favored at a $100,000/QALY threshold only if non-bacteremicpneumococcal pneumonia rate or PCV13 serotype coverage were substantially lower than base case values. Thus, an intervention program to improve pneumococcal vaccine uptake among high-risk 50-64 year-olds was not cost-effective in most scenarios. High-risk individuals receiving both PCV13 and PPSV23 could be economically favorable, and vaccinating all 50-year-olds with both vaccines could be considered.
