title: Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands.
abstract: The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands. Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65-74 years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted. The ICER for base-case was €8650 per QALY (95% CI 5750-17,100). Vaccination of high-risk individuals aged 65-74 years was cost-saving and extension to medium-risk individuals aged 65-74 years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of €3100.PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands These authors contributed equally m.j.j.mangen@umcutrecht.nl.
authors.forename: Marie-Josée J
authors.initials: MJ
authors.lastname: Mangen
authors.affiliation: Pfizer, Capelle a/d IJssel, The Netherlands Unit of Pharmacoepidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands These authors contributed equally.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Rozenbaum
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands These authors contributed equally.
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Huijts
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: van Werkhoven
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Douwe F
authors.initials: DF
authors.lastname: Postma
authors.affiliation: Policy Analysis Inc., Brookline, MA, USA These authors are listed alphabetically.
authors.forename: Mark
authors.initials: M
authors.lastname: Atwood
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Spaarne Gasthuis Academie, Spaarne Gasthuis, Hoofddorp, The Netherlands Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands These authors are listed alphabetically.
authors.forename: Anna M M
authors.initials: AM
authors.lastname: van Deursen
authors.affiliation: Department of Medical Microbiology, Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands These authors are listed alphabetically.
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Julius Clinical, Academic Contract Research Organization, Zeist, The Netherlands These authors are listed alphabetically.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands These authors are listed alphabetically.
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.affiliation: Pfizer Inc., Collegeville, PA, USA These authors are listed alphabetically.
authors.forename: Reiko
authors.initials: R
authors.lastname: Sato
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands These authors are listed alphabetically.
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands These authors are listed alphabetically.
authors.forename: Conrad E
authors.initials: CE
authors.lastname: Vissink
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands Joint senior authors.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Joint senior authors.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000191:economics* / Q000627:therapeutic use*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines