title: 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.
abstract: 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.
authors: Department of Pharmacy, University of Groningen, the Netherlands. m.h.rozenbaum@rug.nl
authors: Mark H
authors: MH
authors: Rozenbaum
authors: Eelko
authors: E
authors: Hak
authors: Tjip S
authors: TS
authors: van der Werf
authors: Maarten J
authors: MJ
authors: Postma
mesh_terms: 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
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines