Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2020 Jun;68(6):1271-1278. doi: 10.1111/jgs.16373. Epub 2020 Feb 22.
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.
Markov decision analysis.
Hypothetical 65-year-old general and black population cohorts.
Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs.
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.
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.
背景/目的：最近修订的美国 65 岁及以上成年人疫苗接种建议包括 23 价肺炎球菌多糖疫苗（PPSV23）和 13 价肺炎球菌结合疫苗（PCV13），基于共同决策，PCV13 现在建议用于免疫功能正常的老年人。该建议的公共卫生影响和成本效益，或肺炎球菌疫苗接种率提高干预措施的成本效益尚不清楚。
马尔可夫决策分析。
假设的 65 岁普通人群和黑人人群队列。
美国老年人当前的肺炎球菌疫苗接种建议，一种免疫功能正常的老年人不使用 PCV13 的替代政策，以及疫苗接种率提高计划。
当前的肺炎球菌疫苗接种建议是最有效的策略，但与替代方案（所有老年人使用 PPSV23 加免疫功能低下者使用 PCV13）相比，提供的公共卫生效益略有增加，并且在任何人群中，疫苗接种率提高计划（绝对接种率增加 12.3%；每位合格患者成本为 1.78 美元）的成本均超过 750000 美元/质量调整生命年（QALY）。替代方案在任何人群中都具有成本优势，但在不考虑或不考虑接种干预措施的情况下，其成本均超过 100000 美元/QALY。敏感性分析结果稳健；然而，在黑人老年人中，在获得 150000 美元/QALY 的阈值下，具有接种计划的替代方案最有可能在概率敏感性分析中受到青睐。
与免疫功能正常者不使用 PCV13 的替代方案相比，美国老年人当前的肺炎球菌疫苗接种建议在经济上是不利的。在黑人人群分析中，具有接种率提高计划的替代方案可能具有经济合理性，如果降低种族差异是一个优先事项，那么该方案可能值得作为一个全面的推荐方案。美国老年医学会 68:1271-1278,2020。
