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Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England

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  • Albert Jan van Hoek
  • Elizabeth Miller

Abstract

Background: Recently a large clinical trial showed that the use of 13-valent pneumococcal conjugate vaccine (PCV13) among immunocompetent individuals aged 65 years and over was safe and efficacious. The aim of this study was to assess the cost-effectiveness of vaccinating immunocompetent 65 year olds with PCV13 vaccine in England. England is a country with universal childhood pneumococcal conjugate vaccination programme in place (7-valent (PCV7) since 2006 and PCV13 since 2010), as well as a 23-valent pneumococcal polysaccharide (PPV23) vaccination programme targeting clinical risk-groups and those ≥65 years. Method: A static cohort cost-effectiveness model was developed to follow a cohort of 65 year olds until death, which will be vaccinated in the autumn of 2016 with PCV13. Sensitivity analysis was performed to test the robustness of the results. Results: The childhood vaccination programme with PCV7 has induced herd protection among older unvaccinated age groups, with a resultant low residual disease burden caused by PCV7 vaccine types. We show similar herd protection effects for the 6 additional serotypes included in PCV13, and project a new low post-introduction equilibrium of vaccine-type disease in 2018/19. Applying these incidence projections for both invasive disease and community-acquired pneumonia (CAP), and using recent measures of vaccine efficacy against these endpoints for ≥65 year olds, we estimate that vaccination of a cohort of immunocompetent 65 year olds with PCV13 would directly prevent 26 cases of IPD, 69 cases of CAP and 15 deaths. The associated cost-effectiveness ratio is £257,771 per QALY gained (using list price of £49.10 per dose and £7.51 administration costs) and is therefore considered not cost-effective. To obtain a cost-effective programme the price per dose would need to be negative. The results were sensitive to disease incidence, waning vaccine protection and case fatality rate; despite this, the overall conclusion was robust. Conclusions: Vaccinating immunocompetent individuals aged ≥65 years with PCV13 is efficacious. However the absolute incidence of vaccine-type disease will likely become very low due to wider benefits of the childhood PCV13 vaccination programme, such that a specific PCV13 vaccination programme targeting the immunocompetent elderly would not be cost-effective.

Suggested Citation

  • Albert Jan van Hoek & Elizabeth Miller, 2016. "Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-14, February.
    • Handle: RePEc:plo:pone00:0149540
    DOI: 10.1371/journal.pone.0149540
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    References listed on IDEAS

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    1. Stavros Petrou & Christine Hockley, 2005. "An investigation into the empirical validity of the EQ‐5D and SF‐6D based on hypothetical preferences in a general population," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1169-1189, November.
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    1. Elizabeth T Cafiero-Fonseca & Andrew Stawasz & Sydney T Johnson & Reiko Sato & David E Bloom, 2017. "The full benefits of adult pneumococcal vaccination: A systematic review," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-23, October.
    2. Dominic Thorrington & Leo van Rossum & Mirjam Knol & Hester de Melker & Hans Rümke & Eelko Hak & Albert Jan van Hoek, 2018. "Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-16, February.
    3. Marina Treskova & Stefan M. Scholz & Alexander Kuhlmann, 2019. "Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions," PharmacoEconomics, Springer, vol. 37(9), pages 1093-1127, September.
    4. Sophie Marbaix & Willy E Peetermans & Jan Verhaegen & Lieven Annemans & Reiko Sato & Annick Mignon & Mark Atwood & Derek Weycker, 2018. "Cost-effectiveness of PCV13 vaccination in Belgian adults aged 65-84 years at elevated risk of pneumococcal infection," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-16, July.
    5. Jung Yeon Heo & Yu Bin Seo & Won Suk Choi & Jacob Lee & Ji Yun Noh & Hye Won Jeong & Woo Joo Kim & Min Ja Kim & Hee Young Lee & Joon Young Song, 2017. "Cost-effectiveness of pneumococcal vaccination strategies for the elderly in Korea," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-17, May.

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