title: Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults.
abstract: BACKGROUND
  The 13-valent pneumococcal conjugate vaccine (PCV13) is approved by the U.S. Food and Drug Administration for adults, but its role in older adults is unclear.
  
  
  OBJECTIVE
  To compare PCV13 strategies to currently recommended vaccination strategies in adults aged ≥65 years.
  
  
  METHODS
  Using a Markov model, the cost effectiveness of PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), alone or in combination, was estimated, in adults aged either 65 years or 75 years. No prior vaccination, prior vaccination, and vaccine hyporesponsiveness scenarios were examined. Pneumococcal disease rates, indirect childhood PCV13 effects, and costs were estimated using CDC Active Bacterial Core surveillance data and U.S. national databases. An expert panel estimated vaccine-related protection. A societal perspective was taken and outcomes were discounted 3% per year.
  
  
  RESULTS
  In those aged 65 years, single-dose PCV13 cost $11,300 per quality-adjusted life-year (QALY) gained compared to no vaccination; at ages 65 and 80 years, PCV13 cost $83,000/QALY. In those aged 75 years, single-dose PCV13 cost $62,800/QALY gained. PPSV23 cost more and was less effective than PCV13. Results were sensitive to varying vaccine effectiveness and indirect effect estimates. In hyporesponsiveness scenarios, cost-effectiveness ratios increased by 37%-78% for single-dose strategies and 29%-35% for multiple-dose strategies.
  
  
  CONCLUSIONS
  Single-dose PCV13 strategies are likely to be economically reasonable in older adults.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: smitkj2@UPMC.EDU.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Wateska
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D006801:Humans; D007115:Immunization Schedule; D008390:Markov Chains; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000191:economics / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: C538862:13-valent pneumococcal vaccine; C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines