Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults
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...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2024-08, Vol.72 (8), p.2423-2433 |
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| creator | Wateska, Angela R. Nowalk, Mary Patricia Altawalbeh, Shoroq M. Lin, Chyongchiou J. Harrison, Lee H. Schaffner, William Zimmerman, Richard K. Smith, Kenneth J. |
| description | 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. databases. 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 |
| doi_str_mv | 10.1111/jgs.19031 |
| format | Article |
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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. databases. 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.
Conclusion
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.
See related Editorial by Melissa K. Andrew in this issue.</description><identifier>ISSN: 0002-8614</identifier><identifier>ISSN: 1532-5415</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.19031</identifier><identifier>PMID: 38822745</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adults ; Aged ; Children ; Cost-Benefit Analysis ; cost‐effectiveness analysis ; Female ; Humans ; Immunization ; Immunization Programs - economics ; Male ; Markov Chains ; older adults ; Older people ; Pneumococcal Infections - economics ; Pneumococcal Infections - prevention & control ; pneumococcal vaccination ; Pneumococcal Vaccines - administration & dosage ; Pneumococcal Vaccines - economics ; Polysaccharides ; Quality-Adjusted Life Years ; Sensitivity analysis ; Serotypes ; United States ; Vaccination - economics ; Vaccine efficacy ; Vaccines ; Vaccines, Conjugate - economics</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2024-08, Vol.72 (8), p.2423-2433</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.</rights><rights>2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2781-9ede0333ec7fd40982334abfd125e928a18475fa9cb3af7f36547e7748df31853</cites><orcidid>0000-0002-1375-8078 ; 0000-0001-8088-566X ; 0000-0001-8345-4048 ; 0000-0001-9441-3508 ; 0000-0002-3787-2705 ; 0000-0001-5941-6092 ; 0000-0003-4541-0161 ; 0000-0002-1702-2690</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.19031$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.19031$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1416,27915,27916,45565,45566</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38822745$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wateska, Angela R.</creatorcontrib><creatorcontrib>Nowalk, Mary Patricia</creatorcontrib><creatorcontrib>Altawalbeh, Shoroq M.</creatorcontrib><creatorcontrib>Lin, Chyongchiou J.</creatorcontrib><creatorcontrib>Harrison, Lee H.</creatorcontrib><creatorcontrib>Schaffner, William</creatorcontrib><creatorcontrib>Zimmerman, Richard K.</creatorcontrib><creatorcontrib>Smith, Kenneth J.</creatorcontrib><title>Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>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. databases. 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.
Conclusion
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.
See related Editorial by Melissa K. Andrew in this issue.</description><subject>Adults</subject><subject>Aged</subject><subject>Children</subject><subject>Cost-Benefit Analysis</subject><subject>cost‐effectiveness analysis</subject><subject>Female</subject><subject>Humans</subject><subject>Immunization</subject><subject>Immunization Programs - economics</subject><subject>Male</subject><subject>Markov Chains</subject><subject>older adults</subject><subject>Older people</subject><subject>Pneumococcal Infections - economics</subject><subject>Pneumococcal Infections - prevention & control</subject><subject>pneumococcal vaccination</subject><subject>Pneumococcal Vaccines - administration & dosage</subject><subject>Pneumococcal Vaccines - economics</subject><subject>Polysaccharides</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Serotypes</subject><subject>United States</subject><subject>Vaccination - economics</subject><subject>Vaccine efficacy</subject><subject>Vaccines</subject><subject>Vaccines, Conjugate - economics</subject><issn>0002-8614</issn><issn>1532-5415</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kb1OHDEQgK0oKByQIi8QWUqTFHv4d-0to1MgICQKoF75vONjL7v2YXuJUBoeIc_Ik8RwQBGJaaaYT59G-hD6RMmcljlcr9KcNoTTd2hGJWeVFFS-RzNCCKt0TcUu2ktpTQhlROsPaJdrzZgScob-LK6NX0HCvcf5GrANKT_c_wXnwOb-FjykhIPDGw_TGGyw1gz41ljbe5P74LHx3dM9hlU0Y8I5FJWNYBLgPic8bbL5BY_6q_nFHIehg4hNNw05HaAdZ4YEH5_3Pro6-nG5-FmdnR-fLL6fVZYpTasGOiCcc7DKdYI0mnEuzNJ1lElomDZUCyWdaeySG6ccr6VQoJTQneNUS76Pvm695cmbCVJuxz5ZGAbjIUyp5aTmoqZS6YJ--Q9dhyn68l2hGtroulGiUN-2lI0hpQiu3cR-NPGupaR9LNKWIu1TkcJ-fjZOyxG6V_IlQQEOt8DvfoC7t03t6fHFVvkPiCyWEQ</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Wateska, Angela R.</creator><creator>Nowalk, Mary Patricia</creator><creator>Altawalbeh, Shoroq M.</creator><creator>Lin, Chyongchiou J.</creator><creator>Harrison, Lee H.</creator><creator>Schaffner, William</creator><creator>Zimmerman, Richard K.</creator><creator>Smith, Kenneth J.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1375-8078</orcidid><orcidid>https://orcid.org/0000-0001-8088-566X</orcidid><orcidid>https://orcid.org/0000-0001-8345-4048</orcidid><orcidid>https://orcid.org/0000-0001-9441-3508</orcidid><orcidid>https://orcid.org/0000-0002-3787-2705</orcidid><orcidid>https://orcid.org/0000-0001-5941-6092</orcidid><orcidid>https://orcid.org/0000-0003-4541-0161</orcidid><orcidid>https://orcid.org/0000-0002-1702-2690</orcidid></search><sort><creationdate>202408</creationdate><title>Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults</title><author>Wateska, Angela R. ; Nowalk, Mary Patricia ; Altawalbeh, Shoroq M. ; Lin, Chyongchiou J. ; Harrison, Lee H. ; Schaffner, William ; Zimmerman, Richard K. ; Smith, Kenneth J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2781-9ede0333ec7fd40982334abfd125e928a18475fa9cb3af7f36547e7748df31853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Children</topic><topic>Cost-Benefit Analysis</topic><topic>cost‐effectiveness analysis</topic><topic>Female</topic><topic>Humans</topic><topic>Immunization</topic><topic>Immunization Programs - economics</topic><topic>Male</topic><topic>Markov Chains</topic><topic>older adults</topic><topic>Older people</topic><topic>Pneumococcal Infections - economics</topic><topic>Pneumococcal Infections - prevention & control</topic><topic>pneumococcal vaccination</topic><topic>Pneumococcal Vaccines - administration & dosage</topic><topic>Pneumococcal Vaccines - economics</topic><topic>Polysaccharides</topic><topic>Quality-Adjusted Life Years</topic><topic>Sensitivity analysis</topic><topic>Serotypes</topic><topic>United States</topic><topic>Vaccination - economics</topic><topic>Vaccine efficacy</topic><topic>Vaccines</topic><topic>Vaccines, Conjugate - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wateska, Angela R.</creatorcontrib><creatorcontrib>Nowalk, Mary Patricia</creatorcontrib><creatorcontrib>Altawalbeh, Shoroq M.</creatorcontrib><creatorcontrib>Lin, Chyongchiou J.</creatorcontrib><creatorcontrib>Harrison, Lee H.</creatorcontrib><creatorcontrib>Schaffner, William</creatorcontrib><creatorcontrib>Zimmerman, Richard K.</creatorcontrib><creatorcontrib>Smith, Kenneth J.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wateska, Angela R.</au><au>Nowalk, Mary Patricia</au><au>Altawalbeh, Shoroq M.</au><au>Lin, Chyongchiou J.</au><au>Harrison, Lee H.</au><au>Schaffner, William</au><au>Zimmerman, Richard K.</au><au>Smith, Kenneth J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2024-08</date><risdate>2024</risdate><volume>72</volume><issue>8</issue><spage>2423</spage><epage>2433</epage><pages>2423-2433</pages><issn>0002-8614</issn><issn>1532-5415</issn><eissn>1532-5415</eissn><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. databases. 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.
Conclusion
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.
See related Editorial by Melissa K. Andrew in this issue.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>38822745</pmid><doi>10.1111/jgs.19031</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-1375-8078</orcidid><orcidid>https://orcid.org/0000-0001-8088-566X</orcidid><orcidid>https://orcid.org/0000-0001-8345-4048</orcidid><orcidid>https://orcid.org/0000-0001-9441-3508</orcidid><orcidid>https://orcid.org/0000-0002-3787-2705</orcidid><orcidid>https://orcid.org/0000-0001-5941-6092</orcidid><orcidid>https://orcid.org/0000-0003-4541-0161</orcidid><orcidid>https://orcid.org/0000-0002-1702-2690</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adults Aged Children Cost-Benefit Analysis cost‐effectiveness analysis Female Humans Immunization Immunization Programs - economics Male Markov Chains older adults Older people Pneumococcal Infections - economics Pneumococcal Infections - prevention & control pneumococcal vaccination Pneumococcal Vaccines - administration & dosage Pneumococcal Vaccines - economics Polysaccharides Quality-Adjusted Life Years Sensitivity analysis Serotypes United States Vaccination - economics Vaccine efficacy Vaccines Vaccines, Conjugate - economics |
| title | Changes in the cost‐effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults |
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