In 2014 the Advisory Committee on Immunization Practices (ACIP) approved a dose of 13-valent pneumococcal conjugate vaccine (PCV13) for all adults at age 65 years. This further complicated the pneumococcal vaccination schedule, which was already one of the most complicated schedules. This study documents simplified schedules that were considered and discarded by the pneumococcal working group before making the most recent recommendation. We examined the marginal cost-effectiveness of several simplified schedules for older adults (age 50+ years) when compared with current recommendations. Our primary outcome was the cost-effectiveness ratio of quality-adjusted life years to cost. We used a probabilistic model following a cohort of 50 year-olds with separate vaccination coverage and disease incidence data for healthy adults and adults at increased risk of pneumococcal disease. We compared incremental cost-effectiveness ratios from the schedule that was ultimately recommended with each potential simplified vaccination strategy. Most schedules analysed resulted in several hundred additional deaths. While several possible schedules resulted in cost savings, these cost savings were modest compared to the health costs associated with them. Conclusion: The schedule recommended by the ACIP in 2014, while complex, is the most health-promoting compared to the modeled alternative schedules. The incremental cost-effectiveness ratio of the current schedule when compared to simplified alternatives is comparable to other vaccine-related interventions.

Removing the risk-based recommendation of receiving PPSV23 for IRPD immunocompetent adults over age 50 decreased health (in terms of total QALYs) for all vaccine schedules we examined. The dollars saved in total cost were small compared to the total health cost. The largest dollars saved per QALY lost were in a recommendation that removed all vaccinations for the general and IRPD populations over age 50. But this only returned $95,192 per QALY lost, which less than the cost per QALY is gained from many recent vaccine interventions. The IPD incidence rate is approximately four times higher in IRPD 50-64 year olds than in the general population (Table 1), which makes targeting them with vaccination highly cost effective. The final column of Table 2 conducts the experiment of removing only the IRPD recommendation for 50-64 year olds while leaving the recommendations for adults age 65 years and older intact. While low coverage rates in the IRPD population suppress the total amount of additional cases and deaths from removing the IRPD specific pneumococcal vaccination, the resulting dollars saved is also very small. This results in a tiny savings per QALY given up.

Thanks & Regards,
John Kimberly
Editorial Manager
Journal of Vaccines & Vaccination
Email: jvv@scholarlypub.com