title: Alternative strategies for adult pneumococcal polysaccharide vaccination: a cost-effectiveness analysis.
abstract: Pneumococcal polysaccharide vaccination (PPV) to prevent invasive pneumococcal disease (IPD) is recommended at age 65 for most persons in the US. We used a Markov model to examine alternative PPV strategies, finding that vaccination at ages 50 and 65 prevented more IPD than present vaccination policies; four decennial vaccinations were most effective. The present vaccination policy costs $3341/QALY gained, vaccinations at 50/65 cost $23,120/QALY and four vaccinations (50/60/70/80) cost $54,451/QALY; results were sensitive to vaccine uptake assumptions, with current policy no longer favored at present vaccination rates. PPV at ages 50/65 may be clinically and, depending on cost-effectiveness criterion used, economically favored over present vaccination recommendations.
authors.affiliation: Section of Decision Sciences and Clinical Systems Modeling, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States. smithkj2@upmc.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Chyongchiou J
authors.initials: CJ
authors.lastname: Lin
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Feng-Shou
authors.initials: FS
authors.lastname: Ko
authors.forename: M Catherine
authors.initials: MC
authors.lastname: McEllistrem
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008070:Lipopolysaccharides / Q000191:economics* / Q000276:immunology*; D008297:Male; D008390:Markov Chains; D008586:Meningitis, Pneumococcal / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D008875:Middle Aged; D015233:Models, Statistical; D011008:Pneumococcal Infections / Q000191:economics* / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000191:economics* / Q000276:immunology*; D012703:Serotyping; D014481:United States
chemical_list: D008070:Lipopolysaccharides; D022242:Pneumococcal Vaccines