Rosenthal Melissa, Stoecker Charles, Leidner Andrew J, Cho Bo-Hyun, Pilishvili Tamara, Kobayashi Miwako
Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.
Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.
Vaccine. 2025 Jan 12;44:126567. doi: 10.1016/j.vaccine.2024.126567. Epub 2024 Dec 6.
In June 2021, the Advisory Committee on Immunization Practices (ACIP) recommended use of either 20-valent pneumococcal conjugate vaccine (PCV20) alone or 15-valent pneumococcal conjugate vaccine (PCV15) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all PCV-unvaccinated adults aged ≥65 years (age-based) and for adults aged 19-64 years with conditions that increase the risk for pneumococcal disease (risk-based). This recommendation replaced a previous recommendation for PPSV23 with or without 13-valent pneumococcal conjugate vaccine (PCV13) for these groups.
We conducted a cost-effectiveness analysis of age-based and risk-based use of either PCV15 in series with PPSV23 or PCV20 alone when compared to previous recommendations.
We utilized probabilistic cohort models of all 65-year-olds (age-based) and 19-year-olds (risk-based through age 64 years and age-based at age 65 years). A spreadsheet-based Monte Carlo simulation software was used to estimate immunization costs, medical costs, non-medical costs, and overall disease burden under different vaccine strategies. The model tracked inpatient invasive pneumococcal disease (IPD) and non-bacteremic pneumonia (NBP) in inpatient and outpatient settings. One-way sensitivity analyses incorporated indirect effects of prospective pediatric vaccination with PCV15 and PCV20 on adult IPD and NBP incidence. Costs were reported in 2021 US dollars. All future costs and outcomes were discounted at 3 % per year.
Age-based use of either PCV20 alone or PCV15 in series with PPSV23 at age 65 years were both shown to be cost-saving (improved health outcomes and saved costs). Combined cost-effectiveness of risk-based (19-64 years) plus age-based (65 years) (risk-and-age-based) use of PCV20 alone was cost-saving, whereas use of PCV15 in series with PPSV23 increased quality-adjusted life years (QALYs) but cost $412,111 (95 % CI: 270,295, 694,869) per QALY gained.
In U.S. adults, replacing the previous recommendations with PCV20 alone or PCV15 in series with PPSV23 improved health outcomes. Except for risk-and-age-based use of PCV15 in series with PPSV23 that resulted in increased cost per QALY gained, the interventions also reduced costs.
2021年6月，免疫实践咨询委员会（ACIP）建议，对于所有未接种过肺炎球菌疫苗的65岁及以上成年人（基于年龄）以及19至64岁患有增加肺炎球菌疾病风险疾病的成年人（基于风险），单独使用20价肺炎球菌结合疫苗（PCV20）或序贯使用15价肺炎球菌结合疫苗（PCV15）和23价肺炎球菌多糖疫苗（PPSV23）。该建议取代了之前针对这些人群使用PPSV23联合或不联合13价肺炎球菌结合疫苗（PCV13）的建议。
我们对与之前的建议相比，基于年龄和基于风险使用PCV15序贯PPSV23或单独使用PCV20进行了成本效益分析。
我们利用了所有65岁人群（基于年龄）和19岁人群（19至64岁基于风险，65岁基于年龄）的概率队列模型。使用基于电子表格的蒙特卡洛模拟软件来估计不同疫苗策略下的免疫成本、医疗成本、非医疗成本和总体疾病负担。该模型跟踪住院和门诊环境中的侵袭性肺炎球菌疾病（IPD）和非菌血症性肺炎（NBP）。单向敏感性分析纳入了PCV15和PCV20前瞻性儿童疫苗接种对成人IPD和NBP发病率的间接影响。成本以2021年美元报告。所有未来成本和结果均按每年3%进行贴现。
单独使用PCV20或在65岁时序贯使用PCV15和PPSV23的基于年龄的使用方式均显示具有成本节约效果（改善了健康结果并节省了成本）。单独使用PCV20的基于风险（19至64岁）加基于年龄（65岁）（基于风险和年龄）的联合成本效益具有成本节约效果，而序贯使用PCV15和PPSV23则增加了质量调整生命年（QALY），但每获得一个QALY的成本为412,111美元（95%CI：270,295，694,869）。
在美国成年人中，用单独的PCV20或PCV15序贯PPSV23取代之前的建议可改善健康结果。除了序贯使用PCV15和PPSV23的基于风险和年龄的使用方式导致每获得一个QALY的成本增加外，这些干预措施还降低了成本。
