Cost-Effectiveness of PCV15, 20 Vaccines Expected to Decrease
Using a cost-utility analysis, researchers addressed the cost-effectiveness of pneumococcal vaccine strategies for adults over the age of 64.
The cost-effectiveness of pneumococcal conjugate vaccine 15-valent and 20-valent (PCV15 and PCV20) is expected to decrease as adults receive herd immunity from childhood vaccination programs, according to a study published in Expert Review of Vaccines.1 While PCV15 and PCV20 were found to decrease disease incidence and mortality, when used with or without PCV23, these vaccines were likely not cost-effective.
“Streptococcus pneumoniae (pneumococcus) is a gram-positive bacterium with 100 known serotypes that causes a wide spectrum of diseases, manifesting either as invasive pneumococcal disease (IPD; e.g. meningitis, bacteremia) or non-invasive disease,” wrote authors of the study. “The pathogen remains the leading cause of morbidity and mortality worldwide, including Canada, particularly affecting young children and adults aged ≥65 years. In Ontario, 42% of IPD cases in 2019 were among older adults and 87% of these cases were hospitalized.”
Researchers found that both PCV15 and PCV20 were more effective than the current PPV23 vaccination program in Ontario. | image credit: jasniulak / stock.adobe.com
In Ontario, where the study was conducted, age- and risk-based guidelines have been offered to help steer pneumococcal vaccination programs. However, pneumococcal disease burden and mortality in Canada continues to be significantly high. Not only are disease-causing serotypes increasing but so is the economic burden of pneumococcal disease.
READ MORE: 24-Valent Pneumococcal Conjugate Vaccine Shows Strong Immune Response in Infants
“The health and economic burden of pneumococcal disease could further increase in the future, not only because of the progressively aging population but also due to the rapid spread of resistant S. pneumoniae strains,” they continued.1 “Between 2014 and 2018, the proportion of vaccine-preventable (PCV13) multi-drug-resistant (MDR) invasive S. pneumoniae infections in Canada increased by 25% (from 9.2% to 11.5%).”
With new PCV combinations releasing on a persistent basis, the 2 newest vaccines that have been approved in Canada were the PCV15 and PCV20 formulas. As these new modes of vaccination have shown the ability to improve both disease burden and mortality, researchers wanted to better understand the economical trade-offs of older adults receiving these vaccines.
PCV15 and 20 could help to address important public health needs by providing broader coverage for serotypes associated with a substantial proportion of pneumococcal diseases. “The National Advisory Committee on Immunization (NACI) in Canada has recommended a single dose of PCV20 for all older adults, with the option of using PCV15 plus [23-valent pneumococcal polysaccharide vaccine] (PPV23) if PCV20 is unavailable and Ontario Immunization Advisory Committee has adopted this recommendation,” they wrote.1 “We conducted a model-based economic evaluation to assess the cost-effectiveness of various pneumococcal vaccination strategies for older adults in Ontario.”
Researchers explored pneumococcal vaccines in 5 different forms: (1) PCV15 alone, (2) PCV20 alone, (3) PCV15 in series with PPV23, (4) PCV20 in series with PPV23, and (5) PPV23 alone. They created a microsimulation model that would place patients 65 and older throughout a variety of health states for 1 full year. Those states included “healthy,” sequelae due to [pneumococcus] infection, and death.
“We conducted a cost-utility analysis using an individual-level state transition model to compare one dose of PCV (alone or in series with PPV23) with PPV23 only,” stated the authors. “We estimated incremental cost-effectiveness ratios (ICERs) expressed in costs per quality-adjusted life year (QALY) from the health care payer perspective, discounted at 1.5% annually.”
Overall, when PCV 15 and PCV20 were separated, both vaccines were more effective than the current PPV23 vaccination program in Ontario. “Use of PCV15 alone resulted in a decrease of 36 IPD episodes and 15 deaths over the lifetime of 100,000 individuals when compared to PPV23-only. Likewise, use of PCV20 alone instead of PPV23 could prevent 46 IPD episodes and 18 deaths,” they continued.1
However, vaccinating older adults with PCV15 or PCV20 only reduced disease burden and mortality at a higher cost than the currently accepted immunization program in Ontario. Moreover, they found similar reductions in cost-effectiveness when PCV15 and PCV20 were used in conjunction with PPV23.
“Our study found that PCV15/20 vaccines (alone or in series with PPV23) may become less economically attractive for older adults in the long-term when considering their potential use in childhood vaccination programs and associated indirect (herd immunity) effects, which is consistent with results of the Public Health Agency of Canada modeling study and the systematic review,” added the authors.1 “Similarly, other studies generally reported higher ICERs when indirect effects were considered. This demonstrates the need to consider comprehensive pneumococcal vaccination program options across age and risk groups when developing recommendations.”
With newly manufactured pneumococcal vaccines appearing regularly, the available options for patients may cause complexities in their perceptions of cost-effectiveness, disease outcomes, and mortality. However, the development of new vaccines may translate to better uptake and decreased pneumococcal disease burden, as childhood disease burden declined upon US acceptance of PCVs in 2000.2
But as herd immunity is expected to protect adults later in their lives, the use of these vaccines may decrease in cost-effectiveness, highlighting the importance of consistently updating PCV evidence and providing education through literature and clinical studies.
“Vaccinating older adults with PCV15/20 likely reduces burden of pneumococcal disease and would be cost-effective initially but is expected to be less economically attractive in the longer term when herd immunity benefits from childhood vaccination programs are considered,” concluded authors of the study.1
READ MORE: Pneumococcal Resource Center
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