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Vaccine. 2013 Aug 20;31(37):3950-6. doi: 10.1016/j.vaccine.2013.06.037. Epub 2013 Jun 24.

Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults.

Author information

1
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. smithkj2@upmc.edu

Abstract

OBJECTIVE:

Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group.

DESIGN:

Markov model-based cost-effectiveness analysis.

METHODS:

The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia.

RESULTS:

In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario.

CONCLUSIONS:

One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.

KEYWORDS:

Cost-effectiveness analysis; Immunocompromising conditions; Pneumococcal vaccination

PMID:
23806240
PMCID:
PMC3742552
DOI:
10.1016/j.vaccine.2013.06.037
[Indexed for MEDLINE]
Free PMC Article

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