Newall A T
a School of Public Health and Community Medicine, University of New South Wales , Sydney , NSW , Australia.
Hum Vaccin Immunother. 2016 Oct 2;12(10):2666-2669. doi: 10.1080/21645515.2016.1197449. Epub 2016 Jul 11.
The cost-effectiveness of 13-type pneumococcal conjugate vaccine (PCV13) use in older adults, and the relative merits when compared to the 23-type polysaccharide pneumococcal vaccine (PPV23), has been a topic of much debate. Although a number of economics evaluations have been conducted many of these were completed before the availability of critical data on PCV13 efficacy in older adults. Recent studies using this data have found conflicting results. This may in part reflect differences in the level of herd protection from infant pneumococcal vaccination programs in different countries. The costs and benefits of pneumococcal vaccination in adults are likely to rest on several critical parameters: the magnitude pneumococcal disease in older adults and the serotypes responsible for it, the efficacy of each vaccine against invasive and non-invasive pneumonia, the duration of vaccine protection, and differences in vaccine price. The ongoing changes in pneumococcal disease patterns highlight the need for economic evaluations to use recent serotype-specific disease estimates from the setting under consideration. In countries that do recommend PCV13 use in adults, post-implementation economic evaluation (using data from after a program is implemented) may be useful to help inform potential future changes to vaccine recommendations as well as the maximum price that should be paid for the vaccines in future negotiations.
13价肺炎球菌结合疫苗（PCV13）在老年人中使用的成本效益，以及与23价肺炎球菌多糖疫苗（PPV23）相比的相对优点，一直是一个备受争议的话题。尽管已经进行了多项经济学评估，但其中许多评估是在关于PCV13在老年人中疗效的关键数据可得之前完成的。最近使用这些数据的研究得出了相互矛盾的结果。这可能部分反映了不同国家婴儿肺炎球菌疫苗接种计划所提供的群体保护水平的差异。成人肺炎球菌疫苗接种的成本和效益可能取决于几个关键参数：老年人中肺炎球菌疾病的严重程度及其相关血清型、每种疫苗对侵袭性和非侵袭性肺炎的疗效、疫苗保护的持续时间以及疫苗价格的差异。肺炎球菌疾病模式的持续变化凸显了经济评估需要使用所考虑环境中近期特定血清型疾病估计值的必要性。在确实建议在成人中使用PCV13的国家，实施后经济评估（使用项目实施后的数据）可能有助于为未来疫苗建议的潜在变化以及未来谈判中疫苗应支付的最高价格提供参考。
