■比利时高级卫生委员会(SHC)优先推荐对65岁以上的成年人使用20价肺炎球菌结合疫苗(PCV20),免疫力低下的患者,和年龄≥50岁的患者患有增加肺炎球菌感染风险的疾病。本文的目的是介绍PCV20与未接种疫苗相比的成本效用,以及该人群中PCV15和23价肺炎球菌多糖疫苗(PPV23)的替代序列。
■分析采用静态马尔可夫模型,捕获肺炎球菌感染的终生风险,相关的无用性,从不同的医疗保健支付者角度来看,死亡率和成本。
■结果表明,与不接种疫苗相比,比利时老年人和高危成年人使用PCV20具有很高的成本效益,每质量调整寿命年(QALY)的增量成本为4,164欧元。与序贯方案(PCV15+PPV23)相比,PCV20疫苗接种是一种节省成本的策略。亚组分析表明,从国家医疗保健的角度来看,65-84岁的高危成年人接种PCV20疫苗也可以节省成本。
■根据现有知识,本分析提示,SHC推荐接种的所有成人都应建议使用PCV20,因为PCV20可以以可承受的成本防止肺炎球菌感染导致的额外住院和死亡.
肺炎球菌感染对感染患者和社会造成很高的负担。几十年来,人们一直建议对有严重感染风险的患者接种疫苗,但是在比利时,成年人的肺炎球菌疫苗摄入量一直很低,如果患者已经承担了疫苗费用,并且推荐的疫苗接种时间表需要依次接种2种疫苗。在比利时,由于年龄或其他因素而有风险的成年人,推荐使用单一剂量的PCV20疫苗,因为它有望为更多类型的致病肺炎球菌提供持久的保护,并且比需要多次注射的替代品更易于施用。随着最近对新的PCV20疫苗的报销,摄入量有望改善,虽然报销只覆盖了推荐人群的一部分。本文详细分析了PCV20在所有严重肺炎球菌疾病风险增加的成年人中的成本效益。包括65岁以下的免疫功能低下的成年人。我们的分析捕获并比较了未接种疫苗的人群中肺炎球菌疾病的终生风险和相关的医疗费用。接受PCV15和PPV23疫苗替代推荐疫苗接种的队列和接受PCV20疫苗接种的队列。这项成本效益分析表明,使用PCV20将有助于减少肺炎球菌疾病的病例数,住院治疗,和以可承受的医疗保健成本过早死亡:在推荐用于肺炎球菌疫苗接种的比利时成年人群中,与不接种疫苗相比,PCV20是一种具有成本效益的选择,与序贯方案PCV15和PPV23相比,PCV20是一种节省成本的选择.
The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (
PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of
PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population.
The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives.
Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23),
PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65-84 years would also be cost-saving from the national healthcare perspective.
Based on current knowledge, this analysis suggests that access to
PCV20 should be proposed in all adults recommended for vaccination by the SHC as
PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost.
Pneumococcal infections cause a high burden on infected patients and society. Vaccination of patients at risk of severe infection has been recommended for decades, but uptake of pneumococcal vaccines in adults has historically been low in Belgium, where patients have borne the vaccine costs and the recommended vaccination schedule required the sequential administration of two vaccines. A single PCV20 dose is recommended as the preferred vaccine for adults at risk due to age or other factors in Belgium as it is expected to provide lasting protection against more types of disease-causing pneumococcal bacteria as well as being simpler to administer than alternatives requiring multiple injections. Uptake is expected to improve with the recent reimbursement of the new PCV20 vaccine, though reimbursement covers only a portion of the recommended population. This paper presents a detailed analysis of the PCV20 cost-effectiveness in all adults at increased risk of severe pneumococcal disease, including immunocompromised adults younger than 65 years. Our analysis captures and compares the lifetime risk of pneumococcal disease and associated healthcare costs in an unvaccinated cohort, a cohort vaccinated with the alternative recommendation of PCV15 and PPV23 vaccines and a cohort vaccinated with PCV20. This cost-effectiveness analysis indicates that use of PCV20 will help decrease the number of pneumococcal disease cases, hospitalizations, and premature deaths at an affordable healthcare cost: PCV20 is a cost-effective option compared to no vaccination and a cost-saving option compared to the sequential regimen PCV15 followed by PPV23 in the Belgian adult population recommended for pneumococcal vaccination.