Cost-effectiveness and budget impact analyses of the 24-valent pneumococcal conjugate vaccine in adults aged 50 and older.

A 24-valent pneumococcal conjugate vaccine (PCV24) is currently in development and could potentially be used in all adults aged 50 years and older. This study evaluated risk- and age-based PCV24 use to ascertain its potential public health effects, budget impact, and cost-effectiveness. A Markov decision analysis model compared PCV24 and all currently recommended pneumococcal vaccines. Age-based vaccination could occur at age 50 or at ages 50 and 65. The analysis separately examined hypothetical cohorts of U.S. Black and non-Black individuals with and without consideration of childhood pneumococcal vaccination indirect effects, using race-specific pneumococcal disease and vaccination data. Cohorts were tracked over a lifetime horizon from both societal and healthcare perspectives. Model parameters were derived from U.S. data and parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Budgetary impact of 21-valent conjugate vaccine (PCV21), PCV24, and combinations of both at different ratios was also assessed. From societal and healthcare perspectives, PCV24 prevented fewer pneumococcal disease cases and deaths but was less economically favorable than strategies using PCV21. Other vaccines were similarly less favorable than PCV21. When adding childhood vaccination indirect effects, PCV24 strategies remained unfavorable compared to PCV21 strategies. In probabilistic sensitivity analyses, PCV21 at ages 50 and 65 was preferred in 99 % of model iterations for Black cohorts and 85 % for non-Blacks at a $100,000/QALY willingness-to-pay threshold. Budget impact for PCV24 and PCV21 were not substantially different but PCV21 prevented more hospitalizations and deaths. Compared to PCV21, which is formulated solely on adult pneumococcal epidemiology, PCV24 and other childhood epidemiology-formulated vaccines were less economically favorable among adults aged 50 and older. Budget impacts of PCV21 and PCV24 use were similar.