Cho Jeong-Yeon, Lee Haeseon, Wannaadisai Warisa, Vietri Jeffrey, Chaiyakunapruk Nathorn
Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Pfizer Ltd., Tadworth, UK.
Vaccine. 2025 Feb 6;46:126656. doi: 10.1016/j.vaccine.2024.126656. Epub 2024 Dec 27.
The economic and public health benefits of adult pneumococcal vaccines vary across countries due to different epidemiology and costs. We systematically reviewed and summarized findings and assumptions of cost-effectiveness analyses (CEA) of the recently introduced 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20) in adults.
We performed a systematic search for CEA studies of PCV15 and/or PCV20 versus existing strategies via PubMed, EMBASE, CEA Registry, EconLit, HTA Database, and NITAG resource center through April 23, 2024. Study characteristics, methods, assumptions, and findings were extracted independently by two reviewers; quality was assessed using ECOBIAS. Results were synthesized qualitatively to summarize key attributes and conclusions.
Of 137 identified records, 26 studies were included; the majority (24/26) concerned high-income countries. All employed static Markov-type models comparing higher-valent PCVs used alone or in combination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) to current recommendations (PPSV23 alone, PCV13 alone, PCV13 + PPSV23, no vaccination). Most studies (22/26) concluded PCV20 used alone was cost-saving (dominant) or cost-effective compared to other adult pneumococcal strategies (PPSV23 alone, PCV13 ± PPSV23, PCV15 ± PPSV23, or no vaccination). PCVs were generally assumed to have serotype-specific effectiveness equal to PCV13 efficacy in the pivotal trial, though four studies used estimates from a Delphi panel; protection was assumed to last between 10 and 20 years. PPSV23 was assumed to have lower effectiveness against non-bacteremic pneumonia and shorter duration of protection. Herd effects from higher-valent PCVs in childhood (12/26), serotype replacement (2/26), or both (1/26) were included in half (13/26) of studies, which attenuated adult vaccine impact. Most studies were assessed as low risk of bias; five abstracts did not provide sufficient information for assessment.
Current evidence indicates that 20-valent PCV used alone is likely to be cost-effective or dominate other adult pneumococcal strategies. Future research is needed to address remaining uncertainties in assumptions and to support evidence-based policymaking.
由于流行病学和成本不同，成人肺炎球菌疫苗的经济和公共卫生效益在各国存在差异。我们系统回顾并总结了近期推出的15价和20价肺炎球菌结合疫苗（PCV15和PCV20）在成人中的成本效益分析（CEA）的研究结果和假设。
我们通过PubMed、EMBASE、CEA注册库、EconLit、卫生技术评估数据库和国家免疫技术咨询小组资源中心，对截至2024年4月23日的PCV15和/或PCV20与现有策略的CEA研究进行了系统检索。两名评审员独立提取研究特征、方法、假设和结果；使用ECOBIAS评估质量。对结果进行定性综合，以总结关键属性和结论。
在137条识别记录中，纳入了26项研究；大多数（24/26）涉及高收入国家。所有研究均采用静态马尔可夫模型，比较单独使用高价PCV或与23价肺炎球菌多糖疫苗（PPSV23）联合使用与当前推荐方案（单独使用PPSV23、单独使用PCV13、PCV13 + PPSV23、不接种疫苗）的效果。大多数研究（22/26）得出结论，单独使用PCV20与其他成人肺炎球菌策略（单独使用PPSV23、PCV13 ± PPSV23、PCV15 ± PPSV23或不接种疫苗）相比具有成本节约（占优）或成本效益。一般假设PCV在关键试验中的血清型特异性效力与PCV13效力相同，不过有四项研究使用了德尔菲专家小组的估计值；假设保护期为10至20年。假设PPSV23对非菌血症性肺炎的效力较低且保护期较短。半数（13/26）研究纳入了儿童期高价PCV的群体效应（12/26）、血清型替换（2/26）或两者兼有（1/26），这减弱了成人疫苗的影响。大多数研究被评估为偏倚风险较低；五篇摘要未提供足够信息进行评估。
目前的证据表明，单独使用20价PCV可能具有成本效益或优于其他成人肺炎球菌策略。需要进一步研究以解决假设中存在的不确定性，并支持基于证据的决策制定。
