Economic Analysis of 15-valent and 20-valent Pneumococcal Conjugate Vaccines among Older Adults in Ontario, Canada
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Introduction
Despite the availability of publicly funded 23-valent polysaccharide pneumococcal vaccine (PPV23) for all adults aged 65 years and older, pneumococcal disease remains a public health concern in Ontario, Canada. Health Canada approved two new pneumococcal conjugate vaccines (PCV), 15-valent (PCV15) and 20-valent (PCV20) and we assessed their cost-effectiveness for older Ontarians.
Methods
We conducted a cost-utility analysis using an individual-level state transition model to compare one dose of PCV (alone or in series with PPV23) with PPV23-only. We estimated sequential incremental cost-effectiveness ratio (ICER) expressed in costs (C$2022) per quality-adjusted life years (QALYs) from the healthcare payer perspective, discounted at 1.5% per annum. We performed sensitivity and scenario analyses to examine impact parameter uncertainties on the results.
Results
A sequential comparison of vaccination strategies with no indirect effect from childhood vaccination resulted in an ICER of $44,324/QALY for PCV15-alone compared to PPV23-only, and $70,751/QALY for PCV20-alone versus PCV15-alone. None of the PCV15/20 combined with PPV23 programs were cost-effective at a cost-effectiveness threshold of C$50,000/QALY. PCV20 alone had an ICER of C$46,961/QALY compared to PPV23-only. When considering the indirect effects, use of PCV15/20 alone or in series with PPV23 were not cost-effective strategies. ICERs were mostly influenced by vaccine characteristics (effectiveness, waning, cost) and the incidence of pneumococcal community- acquired pneumonia.
Conclusion
Vaccinating older adults with PCV15/20 is likely to reduce burden of pneumococcal disease and would be cost-effective initially, but is expected to be less economically attractive in the longer- term when herd immunity benefits from childhood vaccination programs are considered.
