King Laura M, Lewnard Joseph A
School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, United States.
Vaccine. 2024 Dec 2;42(26):126310. doi: 10.1016/j.vaccine.2024.126310. Epub 2024 Sep 10.
Next-generation pneumococcal vaccines currently in clinical trials include 24- and 31-valent pneumococcal conjugate vaccines (PCV24, PCV31), which aim to prevent upper-respiratory carriage and disease involving the targeted serotypes. We aimed to estimate the comprehensive health-economic burden associated with acute respiratory infections (ARIs) and invasive pneumococcal disease (IPD) attributable to PCV24- and PCV31-additional (non-PCV20) serotypes in the United States.
We multiplied all-cause incidence rate estimates for acute otitis media (AOM), sinusitis, and non-bacteremic pneumonia by estimates of the proportions of each of these conditions attributable to pneumococci and the proportions of pneumococcal infections involving PCV24- and PCV31-additional serotypes. We estimated serotype-specific IPD incidence rates using US Active Bacterial Core surveillance data. We accounted for direct medical and non-medical costs associated with each condition to estimate resulting health-economic burden. Non-medical costs included missed work and lost quality-adjusted life years due to death and disability.
The health-economic burden of PCV24-additional serotypes totaled $1.3 ($1.1-1.7) billion annually in medical and non-medical costs, comprised of $0.9 ($0.7-1.2) billion due to ARIs and $0.4 ($0.3-0.5) billion due to IPD. For PCV31-additional serotypes, medical and non-medical costs totaled $7.5 ($6.6-8.6) billion annually, with $5.5 ($4.7-6.6) billion due to ARIs and $1.9 ($1.8-2.1) billion due to IPD. The largest single driver of costs was non-bacteremic pneumonia, particularly in adults aged 50-64 and ≥65 years.
Additional serotypes in PCV24 and PCV31, especially those included in PCV31, account for substantial health-economic burden in the United States.
目前正在进行临床试验的新一代肺炎球菌疫苗包括24价和31价肺炎球菌结合疫苗（PCV24、PCV31），其目的是预防上呼吸道携带以及涉及目标血清型的疾病。我们旨在估计美国因PCV24和PCV31额外（非PCV20）血清型导致的急性呼吸道感染（ARI）和侵袭性肺炎球菌病（IPD）相关的综合健康经济负担。
我们将急性中耳炎（AOM）、鼻窦炎和非菌血症性肺炎的全因发病率估计值乘以这些疾病中可归因于肺炎球菌的比例以及涉及PCV24和PCV31额外血清型的肺炎球菌感染比例。我们使用美国主动细菌核心监测数据估计血清型特异性IPD发病率。我们考虑了与每种疾病相关的直接医疗和非医疗成本，以估计由此产生的健康经济负担。非医疗成本包括因死亡和残疾导致的误工和质量调整生命年损失。
PCV24额外血清型的健康经济负担每年总计13亿美元（11亿 - 17亿美元），其中医疗和非医疗成本包括ARI导致的9亿美元（7亿 - 12亿美元）和IPD导致的4亿美元（3亿 - 5亿美元）。对于PCV31额外血清型，医疗和非医疗成本每年总计75亿美元（66亿 - 86亿美元），其中ARI导致55亿美元（47亿 - 66亿美元），IPD导致19亿美元（18亿 - 21亿美元）。成本的最大单一驱动因素是非菌血症性肺炎，特别是在50 - 64岁和≥65岁的成年人中。
PCV24和PCV31中的额外血清型，尤其是PCV31中的血清型，在美国造成了巨大的健康经济负担。
