Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults.

Abstract:

OBJECTIVE:Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group. DESIGN:Markov model-based cost-effectiveness analysis. METHODS:The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia. RESULTS:In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario. CONCLUSIONS:One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.

journal_name

Vaccine

journal_title

Vaccine

authors

Smith KJ,Nowalk MP,Raymund M,Zimmerman RK

doi

10.1016/j.vaccine.2013.06.037

subject

Has Abstract

pub_date

2013-08-20 00:00:00

pages

3950-6

issue

37

eissn

0264-410X

issn

1873-2518

pii

S0264-410X(13)00815-3

journal_volume

31

pub_type

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