Cost-effectiveness analysis of expanding the adult pneumococcal vaccination recommendations to include adults aged 50 years and older in the United States.

Abstract

Previously, the Advisory Committee on Immunization Practices (ACIP) recommended pneumococcal vaccines for adults aged 19-64 with risk conditions and for all adults aged ≥65. Licensure of 21-valent pneumococcal conjugate vaccine (PCV21) targeting pneumococcal serotypes that commonly cause disease in adults led to consideration of an age-based program for adults aged ≥50 to improve implementation feasibility and achieve broader population protection. Vaccination at age 50 was compared to the previous recommendation using 20-valent or 21-valent pneumococcal conjugate vaccines (PCV20 or PCV21). Two strategies were considered: (1) a single dose at age 50 vs. a single dose at age 65; and (2) one dose at age 50 and a second dose at age 65 vs. one dose at age 65. The single cohort model included pneumococcal disease incidence, mortality, vaccine efficacy, costs, and quality-adjusted life-years (QALY), using a limited societal perspective. Sensitivity analyses were performed to assess the impact of uncertainty. Moving vaccination from age 65 to 50 years reduced pneumococcal disease burden among adults aged 50-64 years but increased burden among adults aged ≥65 years for PCV20 and PCV21. The incremental cost-effectiveness ratio (ICER) was $575,614 saved per QALY lost for PCV21, reflecting reduced costs but an increased disease burden. PCV20 was cost-saving in terms of cost per QALY gained, but indicated worse outcomes in terms of life years, deaths, cases, and hospitalizations. Two-dose vaccination at age 50 and 65 years improved all health outcomes but increased costs. The ICERs were $214,430/QALY gained for PCV21 and $546,811/QALY gained for PCV20. Routine pneumococcal vaccination at both age 50 and age 65 years improved health outcomes but increased costs. PCV21 yielded more favorable values than PCV20 in most scenarios.