title: Age, revaccination, and tolerance effects on pneumococcal vaccination strategies in the elderly: a cost-effectiveness analysis.
abstract: Optimal pneumococcal polysaccharide vaccination (PPV) policy is unknown for cohorts aged > or =65 years. Using a Markov model, we estimated the cost-effectiveness of single- and multiple-dose PPV strategies in 65-, 75-, and 80-year-old cohorts. PPV at age 65 cost $26,100 per QALY (quality adjusted life years) gained. Vaccination at ages 75 and 80 cost $71,300-75,800 per QALY; revaccination strategies cost more. When prior vaccination and loss of vaccine effectiveness due to tolerance are assumed, cost-effectiveness ratios increase substantially. Single-dose PPV is worth considering in patients aged 65-80 from clinical and economic standpoints. Revaccination strategies for the elderly are less cost-effective, particularly when prior vaccination and vaccine tolerance are considered.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA. 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: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D007108:Immune Tolerance; D022242:Pneumococcal Vaccines / Q000191:economics / Q000276:immunology*; D011336:Probability; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics
chemical_list: D022242:Pneumococcal Vaccines