Cost-effectiveness of revised US pneumococcal vaccination recommendations in underserved minority adults < 65-years-old.
Cost-effectiveness of revised US pneumococcal vaccination recommendations in underserved minority adults < 65-years-old.
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DOI：
10.1016/j.vaccine.2022.10.066
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发表时间：
2022-11-28
期刊：
影响因子：
5.5
通讯作者：
Smith, Kenneth J.
中科院分区：
文献类型：
--
作者：
Wateska, Angela R.;Nowalk, Mary Patricia;Lin, Chyongchiou J.;Harrison, Lee H.;Schaffner, William;Zimmerman, Richard K.;Smith, Kenneth J.
摘要背景15价和20价肺炎球菌结合疫苗(PCV15/PCV20)最近被推荐给美国成年人，给65岁以上的所有65岁以上的人和高危年轻人单独接种PCV20或PCV15，然后再接种23价肺炎球菌多糖疫苗(PPSV23)。然而，一般人口建议为所有50岁的人接种疫苗可以减少种族肺炎球菌疾病的差异，因为在服务不足的少数群体中风险更大。方法采用马尔可夫模型对50岁的黑人人群(作为服务不足的少数族裔的代表)和非黑人人群进行研究，评估了美国成人肺炎球菌疫苗接种建议相对于所有50岁以后没有接种疫苗的人的PCV20或PCV15/PPSV23，或50岁和65岁的所有人的PCV20或PCV15/PPSV23的增量成本效益(50/65)。模型参数来自美国数据库、临床试验和德尔福面板。从医疗保健的角度，队列在他们的一生中被跟踪，折扣为3%/年。结果50/65岁接种PCV15/PPSV23对公众健康的影响最大。在黑人队列中，与50岁的PCV20相比，50岁的PCV15/PPSV23的成本为104,723美元/QALY，而50/65岁的PCV15/PPSV23与50岁的PCV15/PPSV23相比，每QALY的成本为240,952美元。在两个队列中，目前的两种推荐方案都比其他战略更昂贵，效果也更差。在敏感性分析中，基于年龄的PCV20或PCV15/PPSV23在50岁或50/65岁使用可能是有利的，这取决于疫苗有效性或不同的疫苗接种率，而当前的建议仍然是不利的。结论最近针对65岁成年人的基于风险的美国成人肺炎球菌疫苗接种建议，与黑人和非黑人队列中所有50岁人群的普通疫苗接种相比，在经济和临床上都是不利的。以年龄为基础的肺炎球菌疫苗接种建议在50岁时可能会减少肺炎球菌疾病负担的不平等。
Abstract Background The 15-and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recently recommended for US adults, giving either PCV20 alone or PCV15 followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) to all 65+-year-olds and to high-risk younger adults. However, general population recommendations to vaccinate all 50-year-olds could reduce racial pneumococcal disease disparities given greater risk in underserved minority populations. Methods A Markov model examining hypothetical 50-year-old Black cohorts (serving as a proxy for underserved minorities) and non-Black cohorts estimated the incremental cost effectiveness of US adult pneumococcal vaccination recommendations compared to PCV20 or PCV15/PPSV23 for all 50-year-olds with no vaccination thereafter, or PCV20 or PCV15/PPSV23 for all at ages 50 and 65 years (50/65). Model parameters came from US databases, clinical trials, and Delphi panels. Cohorts were followed over their lifetimes from a healthcare perspective discounted at 3%/year. Results PCV15/PPSV23 given at ages 50/65 had greatest public health impact. In Black cohorts, PCV15/PPSV23 at age 50 cost $104,723/quality adjusted life year (QALY) gained compared to PCV20 at age 50, while PCV15/PPSV23 at 50/65 cost $240,952/QALY gained compared to PCV15/PPSV23 at age 50. Both current recommendation options were more expensive and less effective than other strategies in both cohorts. In sensitivity analyses, age-based PCV20 or PCV15/PPSV23 use at ages 50 or 50/65 could be favorable depending on vaccine effectiveness or differential vaccine uptake, while current recommendations remained unfavorable. Conclusion Recent risk-based US adult pneumococcal vaccination recommendations for adults< 65-years-old, were economically and clinically unfavorable compared to general population vaccination of all 50-year-olds in Black and non-Black cohorts. An age-based pneumococcal vaccination recommendation at age 50 years may reduce inequities in pneumococcal disease burden.
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影响因子：
3.7
作者：
Said MA;Johnson HL;Nonyane BA;Deloria-Knoll M;O'Brien KL;AGEDD Adult Pneumococcal Burden Study Team;Andreo F;Beovic B;Blanco S;Boersma WG;Boulware DR;Butler JC;Carratalà J;Chang FY;Charles PG;Diaz AA;Domínguez J;Ehara N;Endeman H;Falcó V;Falguera M;Fukushima K;Garcia-Vidal C;Genne D;Guchev IA;Gutierrez F;Hernes SS;Hoepelman AI;Hohenthal U;Johansson N;Kolek V;Kozlov RS;Lauderdale TL;Mareković I;Masiá M;Matta MA;Miró Ò;Murdoch DR;Nuermberger E;Paolini R;Perelló R;Snijders D;Plečko V;Sordé R;Strålin K;van der Eerden MM;Vila-Corcoles A;Watt JP
通讯作者：
Watt JP
影响因子：
120.7
作者：
Jackson, L;Benson, P;Williams, WW
通讯作者：
Williams, WW
影响因子：
5.9
作者：
Wateska, Angela R.;Nowalk, Mary Patricia;Smith, Kenneth J.
通讯作者：
Smith, Kenneth J.
影响因子：
5.7
作者：
Stoecker, Charles;Kim, Lindsay;Pilishvili, Tamara
通讯作者：
Pilishvili, Tamara
影响因子：
39.2
作者：
Sisk, JE;Whang, W;Whitney, CG
通讯作者：
Whitney, CG