修订后的美国肺炎球菌疫苗接种建议在服务不足的少数族裔成年人 < 65 岁人群中的成本效益
Cost-effectiveness of revised US pneumococcal vaccination recommendations in underserved minority adults < 65-years-old.
机构信息
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ohio State University College of Nursing, Columbus, OH, USA.
出版信息
Vaccine. 2022 Nov 28;40(50):7312-7320. doi: 10.1016/j.vaccine.2022.10.066. Epub 2022 Nov 3.
BACKGROUND
The 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recently recommended for US adults, giving either PCV20 alone or PCV15 followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) to all 65 + -year-olds and to high-risk younger adults. However, general population recommendations to vaccinate all 50-year-olds could reduce racial pneumococcal disease disparities given greater risk in underserved minority populations.
METHODS
A Markov model examining hypothetical 50-year-old Black cohorts (serving as a proxy for underserved minorities) and non-Black cohorts estimated the incremental cost effectiveness of US adult pneumococcal vaccination recommendations compared to PCV20 or PCV15/PPSV23 for all 50-year-olds with no vaccination thereafter, or PCV20 or PCV15/PPSV23 for all at ages 50 and 65 years (50/65). Model parameters came from US databases, clinical trials, and Delphi panels. Cohorts were followed over their lifetimes from a healthcare perspective discounted at 3 %/year.
RESULTS
PCV15/PPSV23 given at ages 50/65 had greatest public health impact. In Black cohorts, PCV15/PPSV23 at age 50 cost $104,723/quality adjusted life year (QALY) gained compared to PCV20 at age 50, while PCV15/PPSV23 at 50/65 cost $240,952/QALY gained compared to PCV15/PPSV23 at age 50. Both current recommendation options were more expensive and less effective than other strategies in both cohorts. In sensitivity analyses, age-based PCV20 or PCV15/PPSV23 use at ages 50 or 50/65 could be favorable depending on vaccine effectiveness or differential vaccine uptake, while current recommendations remained unfavorable.
CONCLUSION
Recent risk-based US adult pneumococcal vaccination recommendations for adults < 65-years-old, were economically and clinically unfavorable compared to general population vaccination of all 50-year-olds in Black and non-Black cohorts. An age-based pneumococcal vaccination recommendation at age 50 years may reduce inequities in pneumococcal disease burden.
背景
最近，15 价和 20 价肺炎球菌结合疫苗（PCV15/PCV20）被推荐用于美国成年人，为所有 65 岁及以上人群以及高危年轻成年人接种 PCV20 或 PCV15 序贯 23 价肺炎球菌多糖疫苗（PPSV23）。然而，鉴于服务不足的少数族裔人群面临更大的风险，为所有 50 岁人群接种疫苗的一般人群建议可能会减少种族间肺炎球菌疾病的差异。
方法
使用马尔可夫模型，评估了黑人 50 岁队列（作为服务不足的少数族裔的代表）和非黑人队列，比较了为所有 50 岁人群接种 US 成人肺炎球菌疫苗推荐方案（接种后不再接种任何疫苗）与仅接种 PCV20 或 PCV15/PPSV23、或 50 岁和 65 岁（50/65 岁）时接种 PCV20 或 PCV15/PPSV23 的增量成本效益。模型参数来自美国数据库、临床试验和 Delphi 小组。从医疗保健角度来看，队列在一生中进行了贴现，贴现率为 3%/年。
结果
50/65 岁时接种 PCV15/PPSV23 具有最大的公共卫生影响。在黑人队列中，与 50 岁时接种 PCV20 相比，50 岁时接种 PCV15/PPSV23 的增量成本效益为每获得 1 个质量调整生命年（QALY）需花费 104723 美元，而 50/65 岁时接种 PCV15/PPSV23 的增量成本效益为每获得 1 个 QALY 需花费 240952 美元，而与 50 岁时接种 PCV15/PPSV23 相比。在两个队列中，目前的推荐方案在成本和效果上都不如其他方案。在敏感性分析中，基于年龄的 PCV20 或 PCV15/PPSV23 接种方案在 50 岁或 50/65 岁时的使用可能因疫苗有效性或疫苗接种率的差异而具有优势，而目前的推荐方案仍然不具有优势。
结论
与黑人和非黑人队列中所有 50 岁人群接种疫苗相比，最近基于风险的美国成年人肺炎球菌疫苗接种建议对于 65 岁以下成年人在经济和临床方面均不具有优势。50 岁时基于年龄的肺炎球菌疫苗接种建议可能会减少肺炎球菌疾病负担的不平等。
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