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Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions

Author

Listed:
  • Marina Treskova

    (Leibniz Universität Hannover)

  • Stefan M. Scholz

    (Leibniz Universität Hannover
    Bielefeld University)

  • Alexander Kuhlmann

    (Leibniz Universität Hannover
    German Center for Lung Research (DZL))

Abstract

Background Previous systematic reviews concluded that pneumococcal vaccination in the elderly was cost effective. However, recently published economic evaluations state that it may not be cost effective when children are vaccinated with higher-valent pneumococcal conjugate vaccines. The literature suggests that the outcomes of vaccination in the elderly are strongly influenced by the vaccine effectiveness (VE) against the vaccine-type pneumococcal diseases (PD) and the impact of childhood vaccination on the vaccine-type PD incidence in the elderly, but the extent remains unclear. Methods We conducted a systematic literature search of cost-effectiveness studies on vaccination in the elderly in the PubMed database starting from 2006. We included studies that consider the presence of a childhood vaccination with pneumococcal conjugate vaccine (PCV) 10 and PCV13. We focus on methods and assumptions used in modeling VE and epidemiology of PD over time. Results Twenty-eight economic evaluations underwent full-text review and data extraction. Thirteen were selected for quality assessment. The studies with a higher quality score provide evidence that vaccinating the elderly with PCV13 is not cost effective, when an ongoing rapid decline in the incidence of PCV13-type PD is modeled. A moderate persistence of PCV13 serotypes, in particular due to PCV10 childhood vaccination, makes vaccination of the elderly with PCV13 more attractive. There is no agreement that combining PCV13 with polysaccharide vaccine PPSV23 is cost effective. PPSV23 is attractive when it is effective against non-invasive PD. Conclusion Methodological approaches and assumptions in modeling VE and the indirect effects of childhood vaccination have a major impact on outcomes of decision-analytic models and cost-effectiveness estimates. Considering recently observed trends in the epidemiology of pneumococcal serotypes, there is currently inconclusive evidence regarding the cost effectiveness of pneumococcal vaccination of the elderly due to lack of studies that model key serotypes such as serotype 3 separately from other groups of serotypes.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:pharme:v:37:y:2019:i:9:d:10.1007_s40273-019-00805-5
    DOI: 10.1007/s40273-019-00805-5
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    References listed on IDEAS

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    1. Patrícia Coelho de Soárez & Ana Marli Christovam Sartori & Angela Carvalho Freitas & Álvaro Mitsunori Nishikawa & Hillegonda Maria Dutilh Novaes, 2015. "Cost-Effectiveness Analysis of Universal Vaccination of Adults Aged 60 Years with 23-Valent Pneumococcal Polysaccharide Vaccine versus Current Practice in Brazil," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-15, June.
    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. 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.
    4. Gerhard Falkenhorst & Cornelius Remschmidt & Thomas Harder & Eva Hummers-Pradier & Ole Wichmann & Christian Bogdan, 2017. "Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23) against Pneumococcal Disease in the Elderly: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-18, January.
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