Introduction
Use of the 13-valent pneumococcal conjugate vaccine in nonimmunocompromised adults
aged ≥65 years is controversial. Higher-valency conjugate vaccines (15-valent and
20-valent ) are under development; their potential cost effectiveness in older adults
is unknown, particularly when potential indirect (herd immunity) effects from childhood
vaccination are considered.
Methods
A Markov model estimated the cost effectiveness of current U.S. recommendations and
alternative strategies using currently available and in-development pneumococcal conjugate
vaccines in seniors. Separately, strategies using a hypothetical 20-valent vaccine
adding the 7 most common disease-causing non–13-valent vaccine serotypes were considered.
Sensitivity analyses were performed and alternative scenarios were examined. Data
were gathered and the analyses were performed in 2020.
Results
In analyses considering only existing and in-development vaccines, sole 20-valent
vaccine use cost $172,491/quality-adjusted life year gained compared with current
U.S. recommendations under baseline assumptions (equal serotype effectiveness and
no childhood vaccination indirect effects). Strategies using 15-valent vaccine were
more costly and less effective. When 13-valent/20-valent vaccines were assumed ineffective
against pneumococcal serotype 3 and 15-valent vaccine was fully effective, 15-valent
vaccine cost $237,431/quality-adjusted life year gained. With indirect effects considered,
15-valent or 20-valent vaccine cost >$449,000/quality-adjusted life year gained. When
adding hypothetical 20-valent vaccine under baseline assumptions, hypothetical 20-valent
vaccine cost $139,348/quality-adjusted life year gained.
Conclusions
In-development pneumococcal conjugate vaccines may be economically unreasonable in
older adults, regardless of serotype effectiveness assumptions, particularly when
considering potential indirect effects from use of those vaccines in children. Adult
vaccines containing high-risk serotypes not contained in childhood vaccines may be
more promising.
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Article Info
Publication History
Published online: April 29, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
