Smith Kenneth J, Wateska Angela R, Nowalk Mary Patricia, Lin Chyongchiou J, Harrison Lee H, Schaffner William, Zimmerman Richard K
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Am J Prev Med. 2025 Mar;68(3):518-526. doi: 10.1016/j.amepre.2024.11.014. Epub 2024 Nov 29.
The potential impact of an in-development 24-valent pneumococcal conjugate vaccine compared with that of currently recommended vaccines in older adults is unclear. Similar to most currently available pneumococcal conjugate vaccines, 24-valent pneumococcal conjugate vaccine's formulation is based on childhood pneumococcal disease epidemiology. Decision analysis techniques were used to estimate 24-valent pneumococcal conjugate vaccine cost-effectiveness and public health effects in U.S. older adults.
A Markov model compared 24-valent pneumococcal conjugate vaccine with currently recommended U.S. pneumococcal vaccination strategies in older adults (aged ≥65 years) and with no vaccination. Age-, race-, and chronic medical condition-specific pneumococcal illness risks and serotype-specific disease risks were obtained from Centers for Disease Control and Prevention data. Vaccine effectiveness was estimated using Delphi panel and clinical trial data. Vaccination and pneumococcal illness costs were from U.S.
Scenario analyses examined indirect effects of childhood pneumococcal vaccination on adult disease. Data were collected and analyses were performed in 2024.
The 24-valent pneumococcal conjugate vaccine prevented fewer pneumococcal disease cases and deaths than the recently recommended 21-valent pneumococcal conjugate vaccine, which is formulated on the basis of adult pneumococcal disease serotypes. In cost-effectiveness analyses, 21-valent pneumococcal conjugate vaccine was economically favorable compared with 24-valent pneumococcal conjugate vaccine and all other vaccination strategies, both without and with consideration of potential childhood vaccination indirect effects. These findings were robust and consistent with those in deterministic and probabilistic sensitivity analyses.
In older adults, 24-valent pneumococcal conjugate vaccine was clinically and economically unfavorable compared with 21-valent pneumococcal conjugate vaccine, which covers more adult disease-causing pneumococcal serotypes and is less susceptible to childhood vaccination indirect effects.
与目前推荐给老年人的疫苗相比，一种正在研发的24价肺炎球菌结合疫苗的潜在影响尚不清楚。与目前大多数可用的肺炎球菌结合疫苗类似，24价肺炎球菌结合疫苗的配方是基于儿童肺炎球菌疾病的流行病学情况。决策分析技术被用于评估24价肺炎球菌结合疫苗在美国老年人中的成本效益和公共卫生影响。
一个马尔可夫模型将24价肺炎球菌结合疫苗与目前美国推荐的针对老年人（年龄≥65岁）的肺炎球菌疫苗接种策略以及不接种疫苗的情况进行了比较。特定年龄、种族和慢性疾病状况的肺炎球菌疾病风险以及特定血清型的疾病风险是从疾病控制和预防中心的数据中获取的。疫苗有效性是通过德尔菲专家小组和临床试验数据进行评估的。疫苗接种和肺炎球菌疾病成本来自美国。
情景分析研究了儿童肺炎球菌疫苗接种对成人疾病的间接影响。数据收集于2024年并进行了分析。
与最近推荐的基于成人肺炎球菌疾病血清型配方的21价肺炎球菌结合疫苗相比，24价肺炎球菌结合疫苗预防的肺炎球菌疾病病例和死亡人数更少。在成本效益分析中，无论是否考虑潜在的儿童疫苗接种间接影响，21价肺炎球菌结合疫苗在经济上都比24价肺炎球菌结合疫苗和所有其他疫苗接种策略更具优势。这些发现是稳健的，并且与确定性和概率性敏感性分析的结果一致。
在老年人中，与21价肺炎球菌结合疫苗相比，24价肺炎球菌结合疫苗在临床和经济方面都不利，21价疫苗涵盖了更多导致成人疾病的肺炎球菌血清型，并且受儿童疫苗接种间接影响的可能性较小。
