Thorrington Dominic, van Rossum Leo, Knol Mirjam, de Melker Hester, Rümke Hans, Hak Eelko, van Hoek Albert Jan
Respiratory Diseases Department, Public Health England, London, United Kingdom.
Vaccination Committee, Health Council of The Netherlands, The Hague, The Netherlands.
PLoS One. 2018 Feb 9;13(2):e0192640. doi: 10.1371/journal.pone.0192640. eCollection 2018.
Streptococcus pneumoniae causes morbidity and mortality among all ages in The Netherlands. To reduce this burden, infants in The Netherlands receive the 10-valent pneumococcal conjugated vaccine (PCV10), but older persons are not targeted. We assessed the impact and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) or 13-valent PCV (PCV13) among all those aged 60, 65 or 70 and/or in combination with replacing PCV10 with PCV13 in the infant vaccination programme.
A static cost-effectiveness model was parameterized including projected trends for invasive pneumococcal disease (IPD) and hospitalised community acquired pneumonia (CAP). The different strategies were evaluated using vaccine list prices and a 10-year time horizon. Incremental cost-effectiveness ratios (ICER) were calculated with the current strategy (infant vaccination program with PCV10) as reference.
Compared to the reference, the largest impact on pneumococcal disease burden was projected with a combined use of PCV13 among infants and PPV23 at 60, 65 and 70 years, preventing 1,635 cases of IPD and 914 cases of CAP. The most cost-effective strategy was vaccinating with PPV23 at 70 years only with similar low ICERs at age 60 and 65. The impact of the use of PCV13 among infants depends strongly on the projected herd-immunity effect on serotype 19A. Vaccinating elderly with either PCV13 or PPV23 was dominated by PPV23 in all investigated scenarios, mainly due to the lower price of PPV23.
Under the current assumptions, the best value for money is the use of PPV23 for elderly, with a single dose or at five year increment between age 60 to age 70.
在荷兰，肺炎链球菌可导致各年龄段人群发病和死亡。为减轻这一负担，荷兰的婴儿接种10价肺炎球菌结合疫苗（PCV10），但未针对老年人。我们评估了在所有60岁、65岁或70岁人群中接种23价肺炎球菌多糖疫苗（PPV23）或13价PCV（PCV13）的影响和成本效益，以及在婴儿疫苗接种计划中用PCV13替代PCV10的影响和成本效益。
建立一个静态成本效益模型，设定侵袭性肺炎球菌病（IPD）和医院获得性社区肺炎（CAP）的预测趋势。使用疫苗标价和10年时间范围评估不同策略。以当前策略（婴儿接种PCV10的疫苗接种计划）为参照计算增量成本效益比（ICER）。
与参照策略相比，预计婴儿接种PCV13并在60岁、65岁和70岁人群中接种PPV23对肺炎球菌疾病负担的影响最大，可预防1635例IPD和914例CAP。最具成本效益的策略是仅在70岁人群中接种PPV23,60岁和65岁人群的ICER也较低。婴儿接种PCV13的影响很大程度上取决于对19A血清型的预测群体免疫效应。在所有调查的情况下，用PCV13或PPV23为老年人接种疫苗的策略均不如PPV23，主要原因是PPV23价格较低。
在当前假设下，性价比最高的做法是在60岁至70岁之间为老年人单次接种或每五年接种一次PPV23。
