Cost-effectiveness of vaccination against pneumococcal pneumonia in The Netherlands

Because of the prevalence of pneumococcal pneumonia and thesubstantial morbidity and mortality associated with many pneumococcalinfections, considerable efforts have been made in disease prevention,using a polyvalent polysaccharide pneumococcal vaccine. Althoughthe WHO has endorsed a policy of universal vaccination of allelderly people, the economic aspects of such a policy have notbeen determined. Using a decision tree framework, this paperexamines the cost-effectiveness of various strategies of pneumococcalvaccination for the elderly in The Netherlands. For variousage categories, the economic attractiveness of the vaccinationof all individuals as well as the vaccination of only thoseindividuals with a specific disease has been calculated. Weconclude that, allowing for some uncertainty regarding key variablessuch as the vaccine efficacy and the hospital admission rate,the vaccination of all individuals above the age of 65 yearsis comparable in terms of cost-effectiveness to many existinghealth care interventions. The vaccination of individuals abovethe age of 55 years with chronic lung disease or chronic heartdisease is similarly attractive from an economic point of view,as is the vaccination of individuals above the age of 65 yearswith diabetes mellitus.