What is the cost-benefit analysis of the pneumococcal (Streptococcus pneumoniae) vaccine?

From the Guidelines

Pneumococcal vaccines are a cost-effective intervention, with the cost per quality-adjusted life year (QALY) gained ranging from $87,000 to $611,000, as reported in the most recent study 1. The cost-benefit analysis for pneumococcal vaccines shows favorable outcomes, with the benefits generally outweighing the costs. For adults, the pneumococcal conjugate vaccine (PCV13, Prevnar 13) and pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23) prevent invasive pneumococcal disease, pneumonia, and associated hospitalizations. The typical regimen involves PCV13 followed by PPSV23 one year later for high-risk adults, while healthy adults aged 65+ may receive either vaccine. Some key points to consider include:

• The cost per QALY gained of PCV20 use 5 years after receipt of both PCV13 and PPSV23 compared with no additional vaccination in a single-age cohort of adults aged 65 years was $454,000 with a fifth and 95th percentile range of $308,000–$956,000 in probabilistic sensitivity analyses, as reported in the Tulane-CDC model 1.
• The cost per QALY gained typically was higher if shorter intervals since the last pneumococcal vaccine dose were used, with the cost per QALY gained ranging from $168,000 per QALY gained (PCV20 administered 5 years since PCV13 and PPSV23 administered starting at age 75 years) to $970,000 per QALY gained (PCV20 administered 1 year since PCV13 and PPSV23 administered starting at age 65 years) 1.
• Economic analyses demonstrate that vaccination programs reduce healthcare expenditures through prevented hospitalizations, antibiotic treatments, and outpatient visits, as well as provide indirect protection through herd immunity, reducing transmission in communities 1. While initial program implementation costs can be substantial, especially in low-resource settings, long-term savings from reduced disease burden, decreased antibiotic resistance, and improved productivity make pneumococcal vaccination economically justifiable, particularly in high-risk populations such as the elderly, immunocompromised individuals, and young children 1.

From the FDA Drug Label

The protective efficacy of pneumococcal vaccines containing six (types 1,2,4,8, 12F, and 25) or twelve (types 1,2,3,4, 6A, 8, 9N, 12F, 25, 7F, 18C, and 46) capsular polysaccharides was investigated in two controlled studies in South Africa in male novice gold miners ranging in age from 16 to 58 years, in whom there was a high attack rate for pneumococcal pneumonia and bacteremia. A prospective study in France found a pneumococcal vaccine containing fourteen (types 1,2,3,4, 6A, 7F, 8, 9N, 12F, 14, 18C, 19F, 23F, and 25) capsular polysaccharides to be 77% (95%CI: 51% to 89%) effective in reducing the incidence of pneumonia among male and female nursing home residents with a mean age of 74 (standard deviation of 4 years) A retrospective cohort analysis study based on the U. S. Centers for Disease Control and Prevention (CDC) pneumococcal surveillance system, showed 57% (95%CI: 45% to 66%) overall protective effectiveness against invasive infections caused by serotypes included in PNEUMOVAX 23 in persons ≥6 years of age, 65 to 84% effectiveness among specific patient groups (e.g., persons with diabetes mellitus, coronary vascular disease, congestive heart failure, chronic pulmonary disease, and anatomic asplenia) and 75% (95%CI: 57% to 85%) effectiveness in immunocompetent persons aged ≥65 years of age.

The cost-benefit analysis for pneumococcal vaccine is not directly addressed in the provided drug label. However, the label does provide information on the efficacy of the vaccine in preventing pneumococcal disease.

• The vaccine has been shown to be effective in reducing the incidence of pneumonia and invasive infections caused by serotypes included in the vaccine.
• The protective effectiveness of the vaccine varies depending on the population, with higher effectiveness observed in certain patient groups, such as those with diabetes mellitus or coronary vascular disease.
• The label does not provide information on the cost of the vaccine or the benefits of vaccination in terms of cost savings or quality of life improvements 2.

From the Research

Cost Benefit Analysis for Pneumococcal Vaccine

• The cost-effectiveness of pneumococcal vaccination has been evaluated in several studies 3, 4, 5.
• A study published in The New England Journal of Medicine found that the 13-valent polysaccharide conjugate vaccine (PCV13) was effective in preventing vaccine-type pneumococcal community-acquired pneumonia and invasive pneumococcal disease in adults 65 years of age or older 3.
• Another study published in Human Vaccines & Immunotherapeutics discussed the use of pneumococcal conjugate vaccines (PCVs) in older adults, and noted that the cost-effectiveness of PCVs has changed with the use of PCVs in children 4.
• The Advisory Committee on Immunization Practices (ACIP) has recommended the use of PCVs for all adults aged ≥50 years, and has provided guidance on the use of different PCV formulations 5.
• A literature review and practice guideline update published in Pharmacotherapy discussed the use of pneumococcal vaccines, including PCVs and pneumococcal polysaccharide vaccines (PPSVs), and noted that the development of new PCV formulations has provided an opportunity to use conjugated vaccines against a wider spectrum of pneumococcal serotypes 6.

Factors Affecting Cost Benefit Analysis

• The cost-effectiveness of pneumococcal vaccination is affected by several factors, including the vaccine formulation, the age and risk status of the population, and the prevalence of pneumococcal disease 3, 4, 5.
• The use of PCVs in children has reduced the incidence of conjugate vaccine-type invasive pneumococcal disease in older adults, which has implications for the cost-effectiveness of PCV vaccination in this age group 4.
• The development of new PCV formulations, such as PCV15 and PCV20, has provided an opportunity to use conjugated vaccines against a wider spectrum of pneumococcal serotypes, which may affect the cost-effectiveness of pneumococcal vaccination 5, 6.

Economic Evaluation

• Economic evaluations of pneumococcal vaccination have been conducted using various methods, including cost-effectiveness analysis and cost-utility analysis 3, 4, 5.
• A study published in The New England Journal of Medicine found that PCV13 was cost-effective in preventing vaccine-type pneumococcal community-acquired pneumonia and invasive pneumococcal disease in adults 65 years of age or older 3.
• Another study published in Human Vaccines & Immunotherapeutics discussed the cost-effectiveness of PCVs in older adults, and noted that the cost-effectiveness of PCVs has changed with the use of PCVs in children 4.