PDF(Pubmed)
Abstract：
BACKGROUND: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost-effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs.
METHODS: A Markov model compared no vaccination and current recommendations (either 20-valent pneumococcal conjugate vaccine [PCV20] alone or 15-valent pneumococcal conjugate vaccine plus the 23-valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non-Black 65-year-old cohorts. Pre-pandemic population- and serotype-specific pneumococcal disease risk and illness/vaccine costs came from U.S.
METHODS: Program costs were $2.19 per vaccine-eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon.
RESULTS: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality-adjusted life year (QALY) gained compared with no vaccination; incremental cost-effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non-Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained.
CONCLUSIONS: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.
METHODS: A Markov model compared no vaccination and current recommendations (either 20-valent pneumococcal conjugate vaccine [PCV20] alone or 15-valent pneumococcal conjugate vaccine plus the 23-valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non-Black 65-year-old cohorts. Pre-pandemic population- and serotype-specific pneumococcal disease risk and illness/vaccine costs came from U.S.
METHODS: Program costs were $2.19 per vaccine-eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon.
RESULTS: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality-adjusted life year (QALY) gained compared with no vaccination; incremental cost-effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non-Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained.
CONCLUSIONS: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.
摘要：
背景：多重因素，例如不太复杂的美国成人肺炎球菌建议，可以提高疫苗接种率，儿童肺炎球菌疫苗接种的间接影响，降低成人疫苗接种的影响，和增加疫苗犹豫（特别是在服务不足的少数民族），可能会降低增加老年人肺炎球菌疫苗接种计划的成本效益。先前的分析支持这些计划的经济优势。
方法：马尔可夫模型比较了在黑人和非黑人65岁人群中没有或没有增加疫苗接种的计划和目前的建议（单独的20价肺炎球菌结合疫苗[PCV20]或15价肺炎球菌结合疫苗加23价肺炎球菌多糖疫苗[PCV15/PPSV23]）。大流行前人群和血清型特异性肺炎球菌疾病风险和疾病/疫苗费用来自美国
方法：计划费用为每个符合疫苗资格的人2.19美元，绝对疫苗接种可能性增加7.5%。德尔菲面板估计和试验数据告知疫苗有效性值。分析从医疗保健的角度来看，在一生的时间范围内以3%/年的价格贴现。
结果：摄取计划总体上降低了肺炎球菌疾病。在黑人同伙中，与未接种疫苗相比，无计划的PCV20成本为每个质量调整生命年（QALY）216,805美元；有计划的PCV20的增量成本效益为245,546美元/QALY，有计划的PCV15/PPSV23的增量成本效益为425,264美元/QALY。在非黑人群体中，所有策略的成本>20万美元/季度收益。在考虑儿童疫苗接种的潜在间接影响时，所有战略都变得不那么具有经济吸引力。使用不太复杂的策略增加疫苗接种的效果可以忽略不计。在概率敏感性分析中，当前有或没有项目的建议不太可能在阈值<200,000美元/QALY时受到青睐。
结论：美国目前针对老年人的肺炎球菌疫苗接种建议在有或没有增加疫苗接种的计划的情况下，不可能在经济上合理。应考虑包括与成人疾病相关的肺炎球菌血清型的当前肺炎球菌疫苗的替代方案。
方法：马尔可夫模型比较了在黑人和非黑人65岁人群中没有或没有增加疫苗接种的计划和目前的建议（单独的20价肺炎球菌结合疫苗[PCV20]或15价肺炎球菌结合疫苗加23价肺炎球菌多糖疫苗[PCV15/PPSV23]）。大流行前人群和血清型特异性肺炎球菌疾病风险和疾病/疫苗费用来自美国
方法：计划费用为每个符合疫苗资格的人2.19美元，绝对疫苗接种可能性增加7.5%。德尔菲面板估计和试验数据告知疫苗有效性值。分析从医疗保健的角度来看，在一生的时间范围内以3%/年的价格贴现。
结果：摄取计划总体上降低了肺炎球菌疾病。在黑人同伙中，与未接种疫苗相比，无计划的PCV20成本为每个质量调整生命年（QALY）216,805美元；有计划的PCV20的增量成本效益为245,546美元/QALY，有计划的PCV15/PPSV23的增量成本效益为425,264美元/QALY。在非黑人群体中，所有策略的成本>20万美元/季度收益。在考虑儿童疫苗接种的潜在间接影响时，所有战略都变得不那么具有经济吸引力。使用不太复杂的策略增加疫苗接种的效果可以忽略不计。在概率敏感性分析中，当前有或没有项目的建议不太可能在阈值<200,000美元/QALY时受到青睐。
结论：美国目前针对老年人的肺炎球菌疫苗接种建议在有或没有增加疫苗接种的计划的情况下，不可能在经济上合理。应考虑包括与成人疾病相关的肺炎球菌血清型的当前肺炎球菌疫苗的替代方案。
