Journal Article

The cost-effectiveness of starting 23-valent pneumococcal polysaccharide vaccine and influenza vaccination at 50 vs. 65 years: A comparative modelling study

Chong, Marc, Ding, Hanyue, Kwok, Kin-On, Wang, Harry HX, Ngai, Chun Ho, Wong, Martin CS, Huang, Junjie, Sun, Qingjie

2022

Overview

•We compared strategies of influenza and 23-valent polysaccharide vaccine (PPV23).•When compared with no vaccine, all vaccine strategies were cost-effective.•The earlier age of PPV23 was cost-effective in comparison with current programme.•Our findings could help inform design and implementation of vaccination strategies. Pneumococcal infection is a leading cause of morbidity and mortality. We aimed to evaluate the cost-effectiveness of 23-valent polysaccharide vaccine (PPV23) together with influenza vaccination or pneumococcal vaccination alone in adults starting from 50 years vs. 65 years in Hong Kong. A hypothetical population of 100,000 older adults was included in a Markov model with age ranging from 50 to 85 years to calculate the cost and quality-adjusted life-years (QALYs) gained for vaccination strategies, including: (1) annual influenza vaccine and PPV23 at 50 and 65 years; (2) annual influenza vaccine and PPV23 at 65 years (similar with the current vaccination programme); (3) PPV23 at 50 and 65 years; (4) PPV23 at 65 years; and (5) no vaccination. We evaluated the incremental cost-effectiveness ratio (ICER) and used Monte Carlo simulation for probabilistic sensitivity analysis. The cost-effectiveness threshold was extracted from previous literature. In comparison with no vaccination, all strategies were cost-effective with ICERs less than the threshold (US$24,302 per QALY gained). When compared with no vaccination, strategies 1–4 saved US$ 49.5, US$ 94.9, US$ 584.3, and US$ 1114.2 to gain one QALY respectively. In comparison with strategy 2, strategy 1 spent US$ 195.3 to gain one QALY, whilst strategies 3 and 4 showed less effectiveness with increased costs. All vaccination strategies were cost-effective, among which the strategy of PPV23 at 50/65 years with annual influenza vaccine was cost-effective even in comparison with current vaccination programme. These findings could help inform the design and implementation of vaccination strategies.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adults / Aged / Aged, 80 and over / Allergy and Immunology / Cost analysis / cost effectiveness / Cost-Benefit Analysis / Cost-effective analysis / Fatalities / Humans / Immunization / Influenza / influenza vaccination / influenza vaccines / Influenza, Human - prevention & control / Markov chain / Markov chains / Middle Aged / Monte Carlo method / Monte Carlo simulation / Morbidity / Mortality / Older people / Pneumococcal infection / Pneumococcal Infections - epidemiology / Pneumococcal Vaccines / Polysaccharides / quality-adjusted life year / Quality-Adjusted Life Years / Sensitivity analysis / Streptococcus infections / Streptococcus pneumoniae / Vaccination / Vaccine / Vaccines