title: Cost Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccination Program in Chronic Obstructive Pulmonary Disease Patients Aged 50+ Years in Spain.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) are at elevated risk of pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) was approved for protection against invasive disease and pneumonia caused by Streptococcus pneumoniae in adults. This study estimated the incremental cost-effectiveness ratio (ICER) of vaccinating COPD patients ≥50 years old with PCV13 compared with current vaccination policy (CVP) with 23-valent pneumococcal polysaccharide vaccine.
  
  
  METHODS
  A Markov model accounting for the risks and costs for all-cause non-bacteremic pneumonia (NBP) and invasive pneumococcal disease (IPD) was developed. All parameters, such as disease incidence and costs (€; 2015 values), were based on published data. The perspective of the analysis was that of the Spanish National Healthcare System, and the horizon of evaluation was lifetime in the base case. Vaccine effectiveness considered waning effect over time. Outcomes and costs were both discounted by 3% annually.
  
  
  RESULTS
  Over a lifetime horizon and for a 629,747 COPD total population, PCV13 would prevent 2224 cases of inpatient NBP, 3134 cases of outpatient NBP, and 210 IPD extra cases in comparison with CVP. Additionally, 398 related deaths would be averted. The ICER was €1518 per quality-adjusted life-year (QALY) gained for PCV13 versus CVP. PCV13 was found to be cost effective versus CVP from a 5-year modelling horizon (1302 inpatient NBP and 1835 outpatient NBP cases together with 182 deaths would be prevented [ICER €25,573/QALY]). Univariate and probabilistic sensitivity analyses confirmed the robustness of the model.
  
  
  CONCLUSIONS
  At the commonly accepted willingness-to-pay threshold of €30,000/QALY gained, PCV13 vaccination in COPD patients aged ≥50 years was a cost-effective strategy compared with CVP from 5 years to lifetime horizon in Spain.
authors.affiliation: Department of Pneumology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Rodríguez González-Moro
authors.affiliation: Department of Pneumology, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
authors.affiliation: Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Magda
authors.initials: M
authors.lastname: Campins
authors.affiliation: Medical Department, Pfizer SLU, Alcobendas, Madrid, Spain.
authors.forename: Nadia
authors.initials: N
authors.lastname: Lwoff
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Echave
authors.affiliation: Health Economics and Outcomes Research Department, Pfizer SLU, Avda. de Europa, 20-B, Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain. Javier.rejas@pfizer.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
authors.affiliation: Department of Economics, University of La Rioja, Logroño, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Antoñanzas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D019057:Quality-Adjusted Life Years; D013030:Spain; D014611:Vaccination
chemical_list: C538862:13-valent pneumococcal vaccine; C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines