Cost-Effectiveness of Pneumococcal Vaccines for Adults Aged 65 Years and Older in Argentina

In 2017, the Argentine Ministry of Health incorporated a sequential 13-valent pneumococcal conjugate vaccine (PCV13)-23-valent pneumococcal polysaccharide vaccine (PPSV23) regimen for adults aged ≥65 years to reduce pneumococcal disease burden. Cost-effectiveness analysis of PCV13-PPSV23 schedule for adults aged ≥65 years in Argentina was performed compared with PPSV23 only. Markov model was developed. Local data were incorporated for costs and disease burden analysis. Vaccine efficacy or effectiveness was obtained from a systematic review adjusted to current local vaccine serotype circulation and vaccines coverage. A total of 3 scenarios were evaluated: main scenario according to published literature of pneumonia incidence, epidemiologic surveillance scenario based on Argentine Ministry of Health data, and an alternative scenario assuming a 50% hypothetical pneumonia incidence reduction resulting from herd immunity induced by childhood vaccination. Sensitivity analyses were done. Sequential PCV13-PPSV23 schedule showed cost-savings results in the main scenario with −$1 667 742.23 saved and 716 life-years gained (LYG). The epidemiologic surveillance scenario showed an incremental cost-effectiveness ratio of $2141.92 per LYG and an alternative scenario with $3740.30 per LYG. Tornado diagram shows widest bars related to adjustment for vaccine-type pneumococcal pneumonia (urine analysis) pneumonia at risk cost and pneumonia incidence rate. Monte Carlo simulation shows that >98% of simulations were cost-saving for the main scenario. In the main scenario, cost-saving results were obtained considering only reduction of vaccine serotype coverage after the introduction of childhood PCV13 vaccination. In the epidemiologic surveillance and alternative scenarios, assuming a hypothetical incidence reduction, highly cost-effective results were observed. •Sequential 13-valent pneumococcal conjugate vaccine 23-valent pneumococcal polysaccharide vaccine for adults aged ≥65 years schedule shows cost-savings results in 1 of 3 scenarios, being highly cost-effective in the remaining.•Sensitivity analyses showed as most sensitive inputs were, percentage of adjustment for vaccine-type pneumococcal pneumonia, pneumonia at risk cost, and pneumonia incidence rate.•It is plausible to consider that childhood vaccination in Argentina may have generated herd immunity. Nevertheless, to date, evidence is lacking on whether this effect can be considered in adults in terms of pneumonia in