1097Cost-Effectiveness of Pneumococcal Vaccines for Adults in the United States

Background. Recently published efficacy data for 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPV23) provides an opportunity to update cost-effectiveness analyses of the current ACIP recommendations as well as potential extensions of the ACIP recommendations. Methods. We applied an economic model in a US cohort of 50-year old adults to evaluate the cost-effectiveness of three pneumococcal vaccination strategies. Consistent with ACIP recommendations, the cohort was divided into 3 target vaccination groups at baseline: healthy, immunocompetent-with-comorbidities, and immunocompromised. Vaccination strategies included the 2012 ACIP recommendations (S1) and two other vaccination strategies that either replace PPV23 with PCV13 for healthy and immunocompetent-with-comorbidities adults (S2), or extend the sequential PCV13-then-PPV23 strategy to the three target vaccination groups (S3). Vaccine effectiveness was based on recently published data (table). Sensitivity analyses were conducted to examine the impact of varying assumptions on vaccine effectiveness and the duration of vaccine protection. Results. The most efficient strategy was the 2012 ACIP recommendations (S1), with an ICER of $22,793 per QALY gained compared to no vaccination. Replacing PPV23 with PCV13 for healthy and immunocompetent-with-comorbidities adults (S3) had an ICER of $195,843 per QALY gained. However, adopting a sequential PCV13 -PPV23 strategy for all three groups (S2) was both less effective and less efficient than the S3 strategy. Sensitivity analyses indicated that these results were highly influenced by changes in vaccine efficacy estimates and the duration of vaccine protection.