Changes in the cost-effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults.
Angela R Wateska, Mary Patricia Nowalk, Shoroq M Altawalbeh, Chyongchiou J Lin, Lee H Harrison, William Schaffner, Richard K Zimmerman, Kenneth J Smith
Author Information
Angela R Wateska: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
Mary Patricia Nowalk: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
Shoroq M Altawalbeh: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
Chyongchiou J Lin: Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University College of Nursing, Columbus, Ohio, USA. ORCID
Lee H Harrison: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
William Schaffner: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. ORCID
Richard K Zimmerman: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
Kenneth J Smith: Departments of Medicine and Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ORCID
BACKGROUND: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost-effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. METHODS: A Markov model compared no vaccination and current recommendations (either 20-valent pneumococcal conjugate vaccine [PCV20] alone or 15-valent pneumococcal conjugate vaccine plus the 23-valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non-Black 65-year-old cohorts. Pre-pandemic population- and serotype-specific pneumococcal disease risk and illness/vaccine costs came from U.S. DATABASES: Program costs were $2.19 per vaccine-eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. RESULTS: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality-adjusted life year (QALY) gained compared with no vaccination; incremental cost-effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non-Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. CONCLUSION: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.
