a Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp , Antwerp , Belgium.
b Belgian Health Care Knowledge Centre (KCE) , Brussels , Belgium.
Hum Vaccin Immunother. 2018 May 4;14(5):1218-1229. doi: 10.1080/21645515.2018.1428507. Epub 2018 Feb 22.
Streptococcus pneumoniae causes a high disease burden including pneumonia, meningitis and septicemia. Both a polysaccharide vaccine targeting 23 serotypes (PPV23) and a 13-valent conjugate vaccine (PCV13) are indicated for persons aged over 50 years. We developed and parameterized a static multi-cohort model to estimate the incremental cost-effectiveness and budget-impact of these vaccines at different uptake levels. Using three different vaccine efficacy scenarios regarding non-invasive pneumococcal pneumonia and extensive uni- and multivariate sensitivity analyses, we found a strong preference for PPV23 over PCV13 in all age groups at willingness to pay levels below €300 000 per quality adjusted life year (QALY). PPV23 vaccination would cost on average about €83 000, €60 000 and €52 000 per QALY gained in 50-64, 65-74 and 75-84 year olds, whereas for PCV13 this is about €171 000, €201 000 and €338 000, respectively. Strategies combining PPV23 and PCV13 vaccines were most effective but generally less cost-effective. When assuming a combination of increased duration of PCV13 protection, increased disease burden preventable by PCV13 and a 75% reduction of the PCV13 price, PCV13 could become more attractive in <75 year olds, but would remain less attractive than PPV23 from age 75 years onwards. These observations are independent of the assumption that PPV23 has 0% efficacy against non-invasive pneumococcal pneumonia. Pneumococcal vaccination would be most cost-effective in Belgium, when achieving high uptake with PPV23 in 75-84 year olds, as well as by negotiating a lower market-conform PPV23 price to improve uptake and cost-effectiveness.
肺炎链球菌可引起包括肺炎、脑膜炎和败血症在内的高疾病负担。23 价多糖疫苗（PPV23）和 13 价结合疫苗（PCV13）均适用于 50 岁以上人群。我们开发并参数化了一个静态多队列模型，以评估在不同接种率下这些疫苗的增量成本效益和预算影响。使用关于非侵袭性肺炎球菌性肺炎的三种不同疫苗效力情景以及广泛的单变量和多变量敏感性分析，我们发现，在支付意愿低于每质量调整生命年（QALY）30 万欧元的情况下，在所有年龄组中，PPV23 均优于 PCV13。在 50-64、65-74 和 75-84 岁的人群中，PPV23 接种的平均成本分别为每获得一个 QALY 约 8.3 万欧元、6 万欧元和 5.2 万欧元，而 PCV13 则分别为 17.1 万欧元、20.1 万欧元和 33.8 万欧元。联合使用 PPV23 和 PCV13 疫苗的策略最有效，但通常不太具有成本效益。当假设 PCV13 保护期延长、PCV13 可预防的疾病负担增加以及 PCV13 价格降低 75%时，PCV13 在<75 岁人群中可能更具吸引力，但从 75 岁以上人群开始，PCV13 仍不如 PPV23 有吸引力。这些观察结果独立于 PPV23 对非侵袭性肺炎球菌性肺炎的效力为 0%的假设。在比利时，通过在 75-84 岁人群中高接种率接种 PPV23，或通过谈判降低符合市场规范的 PPV23 价格以提高接种率和成本效益，肺炎球菌疫苗接种将最具成本效益。
