Restivo Vincenzo, Baldo Vincenzo, Sticchi Laura, Senese Francesca, Prandi Gian Marco, Pronk Linde, Owusu-Edusei Kwame, Johnson Kelly D, Ignacio Tim
Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy.
Hygiene and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy.
Vaccines (Basel). 2023 Jul 18;11(7):1253. doi: 10.3390/vaccines11071253.
In Italy, a sequential pneumococcal vaccination with conjugate vaccine (PCV) and polysaccharide vaccine (PPSV23) is recommended for individuals aged ≥ 65 years and those at risk for pneumococcal disease (PD) aged ≥ 6 years. The aim of this study was to assess the cost-effectiveness of the new vaccines, i.e., approved 15-valent and 20-valent PCVs. A published Markov model was adapted to evaluate the lifetime cost-effectiveness of vaccination with PCV15 + PPSV23 versus PCV13 + PPSV23, PCV20 alone, PCV20 + PPSV23, and No Vaccination. Simulated cohorts representing the Italian population, including individuals aged ≥ 65 years, those at risk aged 50-100 years, and those deemed high risk aged 18-100 years were assessed. Outcomes were accrued in terms of incremental PD cases, costs, quality-adjusted life years, life years, and the cost-utility ratio relative to PCV13 + PPSV23. The conservative base case analysis, including vaccine efficacy based on PCV13 data, showed that sequential vaccination with PCV15 or PCV20 in combination with PPSV23 is preferred over sequential vaccination with PCV13 + PPSV23. Especially in the high-risk group, PCV15 + PPSV23 sequential vaccination was dominant over No Vaccination and resulted in an ICUR of €3605 per QALY gained. Including PCV20 + PPSV23 into the comparison resulted in the domination of the PCV15 + PPSV23 and No Vaccination strategies. Additionally, explorative analysis, including the geometric mean titer (GMT) informed vaccine effectiveness (VE) was performed. In the low-risk and high-risk groups, the results of the GMT scenarios showed PCV15 + PPSV23 to be dominant over the other sequential vaccines. These findings suggest that if real-world studies would confirm a difference in vaccine effectiveness of PCV15 and PCV20 versus PCV13 based on GMT ratios, PCV15 + PPSV23 could prove a highly immunogenic and effective vaccination regime for the Italian adult population.
在意大利，建议对65岁及以上人群以及6岁及以上的肺炎球菌疾病（PD）高危人群进行结合疫苗（PCV）和多糖疫苗（PPSV23）的序贯肺炎球菌疫苗接种。本研究的目的是评估新型疫苗，即已获批的15价和20价PCV的成本效益。采用一个已发表的马尔可夫模型来评估PCV15 + PPSV23与PCV13 + PPSV23、单独使用PCV20、PCV20 + PPSV23以及不接种疫苗相比的终生成本效益。对代表意大利人群的模拟队列进行了评估，包括65岁及以上人群、50 - 100岁的高危人群以及18 - 100岁的高风险人群。结果以PD病例增量、成本、质量调整生命年、生命年以及相对于PCV13 + PPSV23的成本效用比来计算。保守的基础病例分析，包括基于PCV13数据的疫苗效力，表明PCV15或PCV20与PPSV23联合进行序贯疫苗接种优于PCV13 + PPSV23序贯接种。特别是在高风险组中，PCV15 + PPSV23序贯接种优于不接种疫苗，每获得一个质量调整生命年的增量成本效用比为3605欧元。将PCV20 + PPSV23纳入比较后，PCV15 + PPSV23和不接种疫苗策略占主导地位。此外，还进行了探索性分析，包括几何平均滴度（GMT）告知的疫苗效力（VE）。在低风险和高风险组中，GMT情景的结果显示PCV15 + PPSV23优于其他序贯疫苗。这些发现表明，如果实际研究能够证实基于GMT比值，PCV15和PCV20相对于PCV13在疫苗效力上存在差异，那么PCV15 + PPSV23可能被证明是一种对意大利成年人群具有高度免疫原性和有效性的疫苗接种方案。
