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PCV13 more cost-effective than PPSV23 among adults
Smith KJ. JAMA. 2012;307:804-812.
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Compared with a 23-valent pneumococcal polysaccharide vaccine, a 13-valent pneumococcal conjugate vaccine was more cost-effective among adults in the United States.
“Conjugate vaccines have been shown to prevent nonbacteremic pneumococcal pneumonia in children,” Kenneth J. Smith, MD, MS, FACP, associate professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine, told Infectious Disease News. “Trials of the current polysaccharide vaccine in community-dwelling older adults have shown efficacy against invasive pneumococcal disease, but not against the much more frequent nonbacteremic pneumonia.”
The 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck) is recommended for the prevention of invasive pneumococcal disease, but there are conflicting studies on its ability to prevent nonbacteremic pneumococcal pneumonia.
Smith and colleagues studied the cost-effectiveness of the vaccines using a Markov state-transition model with a 1-year cycle length. They examined six pneumococcal vaccination strategies. The strategies were then compared using identical hypothetical cohorts of US adults aged 50 years, with cohorts tracked as they aged.
Compared with no vaccination, PPSV23 vaccination costs $34,600 per quality-adjusted life year (QALY) gained. Administration of PCV13 (Prevnar13, Wyeth) cost $28,900 per QALY, compared with no vaccination. Routine PCV13 at ages 50 and 65 years cost $45,100 per QALY. Adding PPSV23 at age 75 years cost $496,000 per QALY gained.
With no vaccination, the estimated lifetime risk from age 50 years onward for hospitalization with nonbacteremic pneumococcal pneumonia was 9.3%. The estimated lifetime risk for hospitalization with invasive pneumococcal disease was 0.86%. The risk for death due to pneumococcal disease was 1.8%.
“We found that adult use of pneumococcal conjugate vaccine would be favored over the current polysaccharide vaccine if the pneumococcal conjugate vaccine prevents nonbacteremic pneumococcal pneumonia,” Smith said. “Whether it prevents this illness in adults is unclear at this point. Physicians should be aware that the new vaccine could prevent more illness than the current one, and that studies to support this contention are ongoing.”
Disclosure: Two study researchers report having a research grant from Merck on HPV vaccine.
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