Economic evaluation of PCV21 in PCV-naïve adults aged 50–64 years in the United States
Zinan Yi, Kwame Owusu‐Edusei, Elamin H. Elbasha
Abstract
OBJECTIVE: In October 2024, the Advisory Committee on Immunization Practices (ACIP) voted to expand the age-based recommendation for pneumococcal vaccination in adults, lowering the youngest age to be vaccinated from 65 to 50 years. This study estimated the incremental health and economic outcomes of age-based use of PCV21 (comparison #1) or PCV20 (comparison #2) versus a previous risk-based recommendation of PCV20 in adults aged 50-64 years in the United States (US). METHODS: A static multi cohort state-transition Markov model was employed to conduct an economic evaluation from a societal perspective with a lifetime time horizon. Model inputs were obtained or derived from published literature and publicly available databases or reports. Outcomes assessed included undiscounted clinical cases: invasive pneumococcal disease (IPD), inpatient and outpatient non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae (PMS), deaths from IPD and inpatient NBPP, as well as discounted (at 3 % per year) quality-adjusted life years (QALYs), total cost (in 2023 USD), and the incremental cost-effectiveness ratios (ICERs) reported as $/QALY gained. Probabilistic/Deterministic sensitivity analysis (PSA/DSA) and scenario analysis were conducted. RESULTS: In all pairwise comparisons, PCV21 (comparison #1) showed a reduction in clinical cases and significantly lower ICERs, at least ten times lower than those observed with PCV20 (comparison #2). The ICER for comparison #1 was $73,000 (95 % uncertainty interval (UI): $40,000, $134,000) per QALY gained. In scenario analyses, the ICER ranged from cost-saving to $80,000/QALY gained. In contrast, the ICER for comparison #2 was $820,000 (95% UI: $572,000, $1.4 million)/QALY gained and varying from $290,000 to $1.0 million/QALY gained in scenario analyses. CONCLUSIONS: An age-based vaccination strategy for adults aged 50-64 years in the US can lead to reductions in pneumococcal disease cases and associated mortality compared to a risk-based strategy. Moreover, PCV21 was a more effective and economically favorable option than PCV20 across a wide range of scenarios and input values.