Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Hum Vaccin Immunother. 2021 Jul 3;17(7):2232-2240. doi: 10.1080/21645515.2020.1861876. Epub 2021 Jan 26.
In June 2019, the Advisory Committee on Immunization Practices (ACIP) changed the recommendation for routine 13-valent pneumococcal conjugate vaccine (PCV13) use in immunocompetent adults aged ≥65 years, including those with select chronic medical conditions (CMC). ACIP now recommends PCV13 for this group of adults based on shared clinical decision-making. Because adults with CMC continue to be at increased risk for pneumococcal disease, we assessed the cost-effectiveness of administering PCV13 in series with the recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥19 years with CMC.We used a probabilistic model following a cohort of 19-year-old adults. We used Monte Carlo simulation to estimate the impact on program, medical, and non-medical costs (in 2017 U.S. dollars [$], societal perspective), and pneumococcal disease burden when administering PCV13 in series with PPSV23. We used PCV13 efficacy and post-licensure vaccine effectiveness (VE) data to estimate VE against PCV13 type disease (separately for disease by serotype 3 [ST3], the most common PCV13 type, and all other PCV13 serotypes). We considered a range of estimates for sensitivity analyses. Analyses were performed in 2019.In the base case, assuming no PCV13 effectiveness against ST3 disease, adding a dose of PCV13 upon CMC diagnosis cost $689,299 per QALY gained. This declined to $79,416 per QALY if VE against ST3 was estimated to be equivalent to other PCV13-types.Administering PCV13 in series with the recommended PPSV23 for adults with CMC was not cost saving. Results were sensitive to estimated PCV13 VE against ST3 disease.
2019 年 6 月，免疫实践咨询委员会（ACIP）改变了免疫功能正常的 65 岁及以上成年人常规使用 13 价肺炎球菌结合疫苗（PCV13）的建议，包括患有某些慢性疾病（CMC）的成年人。ACIP 现在根据共同的临床决策建议为该年龄组的成年人使用 PCV13。由于患有 CMC 的成年人仍然存在患肺炎球菌疾病的风险增加，我们评估了为患有 CMC 的年龄在 19 岁及以上的成年人联合使用推荐的 23 价肺炎球菌多糖疫苗（PPSV23）接种 PCV13 的成本效益。我们使用一个队列 19 岁成年人的概率模型。我们使用蒙特卡罗模拟来估计在为患有 CMC 的 19 岁及以上成年人联合使用 PCV13 和 PPSV23 时，对计划、医疗和非医疗成本（2017 年的美元，社会视角）以及肺炎球菌疾病负担的影响。我们使用 PCV13 的疗效和上市后疫苗有效性（VE）数据来估计针对 PCV13 型疾病的 VE（分别针对血清型 3 [ST3]，最常见的 PCV13 型和所有其他 PCV13 血清型的疾病）。我们考虑了一系列敏感性分析的估计值。分析于 2019 年进行。在基本情况下，如果假设 PCV13 对 ST3 疾病无效，那么在 CMC 诊断时添加一剂 PCV13 将使每 QALY 增加 689299 美元的成本。如果估计针对 ST3 的 VE 与其他 PCV13 型相同，则每 QALY 增加的成本将降至 79416 美元。为患有 CMC 的成年人联合使用推荐的 PPSV23 接种 PCV13 并不能节省成本。结果对估计的针对 ST3 疾病的 PCV13 VE 敏感。
