Pneumococcal Vaccination Strategies in 50-Year-Olds to Decrease Racial Disparities: A US Societal Perspective Cost-Effectiveness Analysis.
Shoroq M Altawalbeh, Angela R Wateska, Mary Patricia Nowalk, Chyongchiou J Lin, Lee H Harrison, William Schaffner, Richard K Zimmerman, Kenneth J Smith
Author Information
Shoroq M Altawalbeh: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Clinical Pharmacy, Jordan University of Science and Technology Faculty of Pharmacy, Irbid, Jordan. Electronic address: smaltawalbeh@just.edu.jo.
Angela R Wateska: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Mary Patricia Nowalk: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Chyongchiou J Lin: The Ohio State University College of Nursing, Columbus, OH, USA.
Lee H Harrison: Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
William Schaffner: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
Richard K Zimmerman: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Kenneth J Smith: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
OBJECTIVES: This study assesses the impact of expanding pneumococcal vaccination to all 50-year-olds to decrease racial disparities by estimating from the societal perspective, the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) and 15-valent conjugate vaccine followed by 23-valent polysaccharide vaccine (PCV15/PPSV23) for 50-year-olds. METHODS: A Markov model compared the cost-effectiveness of PCV20 or PCV15/PPSV23 in all general population 50- and 65-years-olds compared with current US recommendations and with no vaccination in US Black and non-Black cohorts. US data informed model parameters. Pneumococcal disease societal costs were estimated using direct and indirect costs of acute illness and of pneumococcal-related long-term disability and mortality. Hypothetical 50-year-old cohorts were followed over their lifetimes with costs and effectiveness discounted 3% per year. Deterministic and probabilistic sensitivity analyses assessed model uncertainty. RESULTS: In Black cohorts, PCV20 for all at ages 50 and 65 was the least costly strategy and had greater effectiveness than no vaccination and current recommendation strategies, whereas PCV15/PPSV23 at 50 and 65 cost more than $1 million per quality-adjusted life year (QALY) gained compared with PCV20 at 50 and 65. In non-Black cohorts, PCV20 at 50 and 65 cost $62 083/QALY and PCV15/PPSV23 at 50 and 65 cost more than $1 million/QALY with current recommendations, again being more costly and less effective. In probabilistic sensitivity analyses, PCV20 at 50 and 65 was favored in 85.7% (Black) and 61.8% (non-Black) of model iterations at a $100 000/QALY gained willingness-to-pay threshold. CONCLUSIONS: When considering the societal costs of pneumococcal disease, PCV20 at ages 50 and 65 years in the general US population is a potentially economically viable strategy, particularly in Black cohorts.
