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Cost-effectiveness of age-based and risk-based use of the new 21-valent pneumococcal conjugate vaccine among U.S. adults
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Cost-effectiveness of age-based and risk-based use of the new 21-valent pneumococcal conjugate vaccine among U.S. adults
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Cost-effectiveness of age-based and risk-based use of the new 21-valent pneumococcal conjugate vaccine among U.S. adults
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Journal Article
Cost-effectiveness of age-based and risk-based use of the new 21-valent pneumococcal conjugate vaccine among U.S. adults
2026
Overview
In June 2024, the Advisory Committee on Immunization Practices recommended 21-valent pneumococcal conjugate vaccine (PCV21) as an alternative to 15-valent or 20-valent PCV (PCV15 or PCV20) for all PCV-unvaccinated adults aged ≥65 years (age-based) and for adults aged 19–64 years with conditions that increase the risk for pneumococcal disease (risk-based). PCV21 is effective against a different set of serotypes than PCV20.
We conducted a cost-effectiveness analysis of age-based and risk-based use of PCV21 compared with PCV20 among adults in the US.
We utilized probabilistic cohort models of all 65-year-olds (age-based) and 42-year-olds (risk-based through age 64 years and age-based at age 65 years). Monte Carlo simulation was used to estimate immunization costs, medical costs, non-medical costs, and overall disease burden under different vaccine strategies. The model tracked inpatient invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBP) in inpatient and outpatient settings. Since PCV21 does not contain serotype 4 (ST4), we examined the sensitivity of our model to ST4 prevalence. Costs were reported in 2023 US dollars. All future costs and outcomes were discounted at 3 % per year.
Age-based use of PCV21 costs $4132 (95 % confidence interval [CI]: cost-saving, $18,599) per quality-adjusted life year (QALY) gained. Risk-based use of PCV21 was cost-saving (95 % CI: cost-saving, cost-saving). Age-based use of PCV21 was dominated (had lower QALYs and higher costs) compared with PCV20 when ST4 caused >30 % of pneumococcal disease. Similarly, risk-based use of PCV21 was dominated when ST4 caused >35 % of pneumococcal disease.
Among US adults, replacing the previous recommendation of PCV20 with PCV21 improved health outcomes, incurred modest costs at age 65, and decreased costs for risk-based recommendations. In areas where ST4 comprises a high percentage of pneumococcal disease, however, PCV20 is expected to prevent more disease and reduce costs compared to PCV21.
Publisher
Elsevier Ltd,Elsevier Limited
Subject
/ Adults
/ Age
/ Aged
/ Female
/ Humans
/ Male
/ Medicare
/ Pneumococcal conjugate vaccine
/ Pneumococcal Infections - economics
/ Pneumococcal Infections - epidemiology
/ Pneumococcal Infections - prevention & control
/ Pneumococcal Vaccines - administration & dosage
/ Pneumococcal Vaccines - economics
/ Pneumococcal Vaccines - immunology
/ risk
/ Streptococcus pneumoniae - immunology
/ United States - epidemiology
/ Vaccines
