Cost-effectiveness of an in-development adult-formulated pneumococcal vaccine in older US adults |
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| Institution: | 1. University of Pittsburgh School of Medicine, Pittsburgh, PA, United States;2. The Ohio State University College of Nursing, Columbus, OH, United States;3. Vanderbilt University School of Medicine, Nashville, TN, United States;1. Service Hygiène, Epidémiologie et Prévention, Centre Hospitalier Hôpital Eduard Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex, France;2. CIRI, Centre International de Recherche en Infectiologie, (Team Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID)), Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007 Lyon, France;3. Centre for Excellence in Respiratory Pathogens, Hospices Civils de Lyon, Lyon, France;4. South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;5. Internal Medicine, University Hospital Edouard Herriot, Hospices Civils de Lyon, France;6. Service de Gériatrie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France;7. Laboratoire de Virologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;8. Virpath - Grippe, de l’émergence au contrôle, Centre International de Recherche en Infectiologie (CIRI), Inserm U111, CNRS 5308, ENS, UCBL1, Faculté de Médecine RTH Laënnec, Lyon, France;1. GSK, Siena, Italy;2. GSK, Wavre, Belgium;3. GSK, Rockville, MD, USA;4. GSK, Amsterdam, Netherlands;5. DESiRE-consulting, Belgium;6. Fondazione Biotecnopolo di Siena, Italy;1. School of Life Science, Ludong University, 186# Hong-Qi-Zhong Street, Zhifu, Yantai 264000, Shandong, China;2. State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20# Dong-Da-Jie Street, Fengtai, Beijing 100071, China;3. College of Life Sciences, Hebei Normal University, 20# Nan-Er-Huan-Dong Street, Yuhua, Hebei 050010, China;1. Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark;2. Faculty of Medicine and Health Technology, Tampere University, and FVR – Finnish Vaccine Research, Tampere, Finland;3. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy;4. Finnish Vaccine Research, Tampere, Finland;5. The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel;6. School of Medicine, University of Western Australia, Perth, Australia;7. Merck & Co., Inc., Rahway, NJ, USA;8. MSD, Zürich, Switzerland;9. MSD (UK) Limited, London, United Kingdom;1. Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20903, United States;2. Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States;3. Epidemiology Research and Innovations Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States;1. Centre de recherche du CHU de Québec-Université Laval, 2400 avenue d''Estimauville, Québec, Québec G1E 6W2, Canada;2. Institut national de santé publique du Québec, 2400 avenue d’Estimauville, Québec, Québec G1E 7G9, Canada;4. School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2, Canada;5. Department of Pediatrics, Dalhousie University, 5849 University Avenue, Halifax, Nova Scotia B3H 4H7, Canada;6. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada;7. Department of Pediatrics, Dalhousie University, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada;8. School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada;9. Department of Communication, University of Massachusetts Amherst, N308 Integrative Learning Center, 650 N. Pleasant Street, Amherst, MA 01003, USA;10. Département d’anthropologie, Université Laval, Pavillon Charles-De Koninck, bureau 3433, 1030 avenue des Sciences Humaines, Québec, Québec G1V 0A6, Canada |
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| Abstract: | IntroductionCDC pneumococcal vaccination recommendations for older adults now include either 15- or 20-valent pneumococcal conjugate vaccine (PCV15/PCV20). However, an in-development 21-valent vaccine (PCV21), formulated based on adult pneumococcal disease epidemiology, could substantially increase coverage of disease-causing pneumococcal serotypes, particularly in Black older adults, who are at greater risk. The potential public health impact and cost-effectiveness of PCV21 compared to currently recommended vaccines in older adults is unclear.MethodsA Markov decision model compared current pneumococcal vaccination recommendations to PCV21 use in Black and non-Black 65-year-old cohorts. CDC Active Bacterial Core surveillance data informed population and serotype-specific pneumococcal disease risk. Vaccine effectiveness was estimated using Delphi panel estimates and clinical trial data, with variation in sensitivity analyses. Potential indirect effects on adult disease from PCV15 childhood vaccination were examined. All model parameters were varied individually and collectively in sensitivity analyses. Scenarios with decreased PCV21 effectiveness and potential COVID-19 pandemic effects were also examined.ResultsIn the Black cohort, the PCV21 strategy cost $88,478 per quality adjusted life-year (QALY) gained without and $97,952/QALY with childhood PCV15 indirect effects. PCV21 in the non-Black cohort cost $127,436/QALY gained without and $141,358/QALY with childhood PCV15 effects. Current recommendation strategies were economically unfavorable, regardless of population or indirect childhood vaccination effects. Results favoring PCV21 use were robust in sensitivity analyses and alternative scenarios.ConclusionAn in-development PCV21 vaccine would likely be economically and clinically favorable compared to currently recommended pneumococcal vaccines in older adults. While PCV21 was more favorable in Black cohort analyses, results for both Black and non-Black populations were economically reasonable, highlighting the potential importance of adult-specific pneumococcal vaccine formulations and, pending further investigation, potentially justifying a future general population recommendation for PCV21 use in older adults. |
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