Results of a cohort model analysis of the cost-effectiveness of routine immunization with 13-valent pneumococcal conjugate vaccine of those aged > or =65 years in the Netherlands.
BACKGROUND
Community-acquired pneumonia and invasive pneumococcal disease are common among older people (ie, those aged > or =65 years). A new 13-valent pneumococcal conjugate vaccine (PCV-13) is under study in the Netherlands.


OBJECTIVE
The aim of this work was to model the cost-effectiveness of PCV-13 vaccination among those aged > or =65 years in the Netherlands, both in the total population and in those at increased risk for pneumonia, for various levels of efficacy (30%-90%) assumed.


METHODS
Our previously published cost-effectiveness model was updated to include age-specific epidemiologic data and health-care utilization and costs for a hypothetical cohort of adults aged > or =65 years in the Netherlands. This cohort was followed twice-once as unvaccinated and once as vaccinated-over a time period of 5 years, with differences between both analyses reported. Outcome measures included costs, life-years gained (LYGs), quality-adjusted life-years, and incremental cost-effectiveness ratios (ICERs). All analyses were performed from a societal perspective.


RESULTS
In the model, the ICER for vaccination remained below euro80,000/LYG, except when the vaccine was assumed to protect only against bacteremic pneumonia, with a relatively low effectiveness (40%) in combination with a high vaccine price (euro65), and indirect effects of serotype replacement would largely offset the direct effect of vaccination. For various assumptions, introduction of widespread PCV-13 vaccination (assuming a 60% efficacy against invasive and noninvasive disease because of vaccine serotypes, and a cost of euro50 per vaccinated person) was associated with the ICERs varying from cost-saving to euro50,676/LYG.


CONCLUSIONS
In this model analysis of a hypothetical cohort in the Netherlands, vaccination with PCV-13 might be considered cost-effective, both for the total population and for the high-risk population aged > or =65 years, from a societal perspective, over a 5-year time horizon. The main limitation of this study was uncertainty regarding how great a proportion of pneumonia could be attributed to pneumococcal disease.
Rozenbaum
Mark H
MH
Department of Pharmacy, University of Groningen, the Netherlands. m.h.rozenbaum@rug.nl
Hak
Eelko
E
van der Werf
Tjip S
TS
Postma
Maarten J
MJ
D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D018803:Models, Economic; D009426:Netherlands / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D011018:Pneumonia, Pneumococcal / Q000191:economics / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines