Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA.
Pfizer Canada Inc., Kirkland, Quebec, Canada.
Can J Public Health. 2018 Dec;109(5-6):756-768. doi: 10.17269/s41997-018-0050-9. Epub 2018 May 9.
The Canadian National Advisory Committee on Immunization (NACI) recommends use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in a sequential schedule (PCV13 → PPV23) among adults aged ≥ 65 years and those aged ≥ 18 years who are immunocompromised. In light of recent PCV13 efficacy data from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), and new sero-epidemiology data on community-acquired pneumonia (CAP), we examined the economic implications of funding an expanded adult pneumococcal immunization program in Canada.
A microsimulation model depicting expected lifetime risks, consequences, and costs of invasive pneumococcal disease (IPD) and CAP was developed. PPV23 effectiveness was based on published literature, and PCV13 effectiveness was based on CAPiTA; all other model parameters were based on published data or secondary sources. Herd effects from the PCV13 pediatric program were considered. Outcomes and costs were evaluated assuming use of PPV23 alone, and alternatively, use of PCV13 → PPV23 among (1) all adults aged ≥ 65 years (n = 5.4 M) and (2) immunocompromised and high-risk adults aged ≥ 65 years (n = 3.0 M).
For population no. 1, PCV13 → PPV23 reduced IPD cases by 1100, CAP cases by 7000, and disease costs by $135.8M; vaccination costs increased by $254.3M, and cost per QALY gained was $35,484. For population no. 2, PCV13 → PPV23 reduced IPD cases by 900, CAP cases by 6000, and disease costs by $120.3M; vaccination costs increased by $149.8M, and cost per QALY gained was $10,728.
Expanding use of PCV13 → PPV23 by funding PCV13 among Canadian adults aged ≥ 65 would be a cost-effective use of healthcare resources.
加拿大国家免疫咨询委员会（NACI）建议在 65 岁及以上老年人和免疫功能低下的 18 岁及以上人群中，采用 13 价肺炎球菌结合疫苗和 23 价肺炎球菌多糖疫苗序贯接种（PCV13→PPV23）。鉴于成人社区获得性肺炎免疫接种试验（CAPiTA）最近公布的 PCV13 疗效数据，以及社区获得性肺炎（CAP）的新血清流行病学数据，我们研究了在加拿大扩大成人肺炎球菌免疫计划的经济意义。
开发了一个描述侵袭性肺炎球菌病（IPD）和 CAP 预期终生风险、后果和成本的微观模拟模型。PPV23 的有效性基于已发表的文献，PCV13 的有效性基于 CAPiTA；所有其他模型参数均基于已发表的数据或二级来源。考虑了 PCV13 儿科计划的群体效应。假设仅使用 PPV23（1）所有 65 岁及以上成年人（n=540 万）和（2）免疫功能低下和高风险 65 岁及以上成年人（n=300 万），评估了结果和成本。
对于人群 1，PCV13→PPV23 减少了 1100 例 IPD 病例、7000 例 CAP 病例和 1.358 亿美元的疾病成本；疫苗接种成本增加了 2.543 亿美元，每获得一个质量调整生命年（QALY）的成本为 35484 美元。对于人群 2，PCV13→PPV23 减少了 900 例 IPD 病例、6000 例 CAP 病例和 1.203 亿美元的疾病成本；疫苗接种成本增加了 1.498 亿美元，每获得一个质量调整生命年（QALY）的成本为 10728 美元。
通过为加拿大 65 岁及以上成年人提供 PCV13 疫苗接种来扩大 PCV13→PPV23 的使用，将是一种具有成本效益的医疗资源利用方式。
