University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
The Ohio State University College of Nursing, Columbus, OH, United States.
Vaccine. 2023 Jul 5;41(30):4431-4437. doi: 10.1016/j.vaccine.2023.06.007. Epub 2023 Jun 12.
CDC pneumococcal vaccination recommendations for older adults now include either 15- or 20-valent pneumococcal conjugate vaccine (PCV15/PCV20). However, an in-development 21-valent vaccine (PCV21), formulated based on adult pneumococcal disease epidemiology, could substantially increase coverage of disease-causing pneumococcal serotypes, particularly in Black older adults, who are at greater risk. The potential public health impact and cost-effectiveness of PCV21 compared to currently recommended vaccines in older adults is unclear.
A Markov decision model compared current pneumococcal vaccination recommendations to PCV21 use in Black and non-Black 65-year-old cohorts. CDC Active Bacterial Core surveillance data informed population and serotype-specific pneumococcal disease risk. Vaccine effectiveness was estimated using Delphi panel estimates and clinical trial data, with variation in sensitivity analyses. Potential indirect effects on adult disease from PCV15 childhood vaccination were examined. All model parameters were varied individually and collectively in sensitivity analyses. Scenarios with decreased PCV21 effectiveness and potential COVID-19 pandemic effects were also examined.
In the Black cohort, the PCV21 strategy cost $88,478 per quality adjusted life-year (QALY) gained without and $97,952/QALY with childhood PCV15 indirect effects. PCV21 in the non-Black cohort cost $127,436/QALY gained without and $141,358/QALY with childhood PCV15 effects. Current recommendation strategies were economically unfavorable, regardless of population or indirect childhood vaccination effects. Results favoring PCV21 use were robust in sensitivity analyses and alternative scenarios.
An in-development PCV21 vaccine would likely be economically and clinically favorable compared to currently recommended pneumococcal vaccines in older adults. While PCV21 was more favorable in Black cohort analyses, results for both Black and non-Black populations were economically reasonable, highlighting the potential importance of adult-specific pneumococcal vaccine formulations and, pending further investigation, potentially justifying a future general population recommendation for PCV21 use in older adults.
美国疾病控制与预防中心（CDC）对老年人的肺炎球菌疫苗接种建议现在包括 15 价或 20 价肺炎球菌结合疫苗（PCV15/PCV20）。然而，一种正在开发的 21 价疫苗（PCV21），基于成人肺炎球菌疾病的流行病学而制定，可能会大大增加引起疾病的肺炎球菌血清型的覆盖率，尤其是在黑人老年人中，他们的风险更高。与目前推荐的老年人用疫苗相比，PCV21 的潜在公共卫生影响和成本效益尚不清楚。
使用马尔可夫决策模型将目前的肺炎球菌疫苗接种建议与黑人及非黑人 65 岁人群中使用 PCV21 进行比较。CDC 主动细菌核心监测数据提供了人群和血清型特异性肺炎球菌疾病风险信息。疫苗效力使用德尔菲小组估计和临床试验数据进行估计，并在敏感性分析中进行了变化。还研究了 PCV15 儿童疫苗接种对成人疾病的潜在间接影响。在敏感性分析中，单独和集体地对所有模型参数进行了变化。还研究了 PCV21 效力降低和潜在 COVID-19 大流行影响的情况。
在黑人队列中，PCV21 策略在没有儿童时期 PCV15 间接影响的情况下，每获得一个质量调整生命年（QALY）的成本为 88478 美元，而有间接影响的情况下则为 97952 美元/QALY。在非黑人队列中，PCV21 策略在没有儿童时期 PCV15 间接影响的情况下，每获得一个 QALY 的成本为 127436 美元，而有间接影响的情况下则为 141358 美元/QALY。无论人群或儿童时期 PCV15 间接效应如何，目前的推荐策略在经济上都不利。在敏感性分析和替代方案中，支持使用 PCV21 的结果是稳健的。
与目前推荐的老年人用肺炎球菌疫苗相比，正在开发的 PCV21 疫苗在经济和临床方面可能更具优势。虽然在黑人队列分析中 PCV21 更有利，但黑人和非黑人人群的结果在经济上都是合理的，这突出了成人特异性肺炎球菌疫苗制剂的重要性，并且在进一步调查的基础上，可能证明未来对老年人使用 PCV21 进行一般人群推荐是合理的。
