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Cost-Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations.

Abstract：

BACKGROUND/OBJECTIVES:Recently revised vaccination recommendations for US adults, aged 65 years and older, include both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost-effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear. DESIGN:Markov decision analysis. SETTING AND PARTICIPANTS:Hypothetical 65-year-old general and black population cohorts. INTERVENTION:Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs. RESULTS:The current pneumococcal vaccination recommendation was the most effective strategy, but afforded slight public health benefits compared to an alternative (PPSV23 for all older people plus PCV13 for the immunocompromised) and cost greater than $750 000 per quality-adjusted life-year (QALY) gained in either population group with a vaccine uptake improvement program (absolute uptake increase = 12.3%; cost = $1.78/eligible patient) in place. The alternative strategy was more economically favorable, but cost greater than $100 000/QALY in either population, with or without an uptake intervention. Results were robust in sensitivity analyses; however, in black older people, the alternative strategy with an uptake program was most likely to be favored in probabilistic sensitivity analyses at a $150 000/QALY gained threshold. CONCLUSION:Current pneumococcal vaccination recommendations for US older people are economically unfavorable compared to an alternative strategy omitting PCV13 in the immunocompetent. The alternative recommendation with an uptake improvement program may be economically reasonable in black population analyses and could be worth considering as a population-wide recommendation if mitigating racial disparities is a priority. J Am Geriatr Soc 68:1271-1278, 2020.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Wateska AR,Nowalk MP,Lin CJ,Harrison LH,Schaffner W,Zimmerman RK,Smith KJ

doi

10.1111/jgs.16373

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1271-1278

issue

eissn

0002-8614

issn

1532-5415

journal_volume

pub_type

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Cost-Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations.