Cost-effectiveness analyses of 15- and 20-valent pneumococcal conjugate vaccines for Japanese elderly
Cost-effectiveness analyses of 15- and 20-valent pneumococcal conjugate vaccines for Japanese elderly
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日本老年人接种 15 价和 20 价肺炎球菌结合疫苗的成本效益分析
DOI：
10.1016/j.vaccine.2022.10.010
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发表时间：
2022
期刊：
影响因子：
5.5
通讯作者：
Kondo Masahide
中科院分区：
文献类型：
--
作者：
Hoshi Shu-ling;Shono Aiko;Seposo Xerxes;Okubo Reiko;Kondo Masahide
背景尽管实施了23价肺炎球菌多糖疫苗(PPSV23)接种计划，但肺炎球菌病(PD)仍然是日本老年人发病率和死亡率的重要原因，特别是因为儿童肺炎球菌结合疫苗(PCV)接种计划继续改变PD血清型在老年人中的分布。最近，在美国，PCV15/PCV20被推荐给65岁的≥和19-岁有一定基础条件的成年人。在日本，PCV15正在审批申请过程中，PCV20正在进行临床试验，这证明有必要评估它们的性价比。方法采用马尔可夫模型进行成本-效果分析，从支付者的角度计算疫苗接种增量成本-效果比。估计质量调整寿命年(QALY)和疾病治疗成本的转移概率和效用权重是从文献中估计或获得的。为了反映新冠肺炎疫情的情况，使用了2020年及以后的流行病学数据。结果与现行疫苗接种方案相比，PCV20疫苗接种方案以更低的成本获得了更多的QALY，而PCV15疫苗接种方案多获得了35,020元(318美元，1美元=110元)的QALY。将PPSV23疫苗接种计划改为PCV20疫苗接种计划是节省成本的。单向敏感性分析显示，降低非细菌性肺炎(NBP)疫苗的VE下限对改变以PCV20疫苗接种为主的PPSV23疫苗接种方案为以PPSV23疫苗接种方案为主的PCV20疫苗接种方案有较大影响。结论在新冠肺炎时代，在日本为65岁的成年人提供单剂卡介苗15或卡介苗20来取代目前的卡介苗23是非常划算的，而卡介苗20被观察到更有利。
Background Despite the 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination programme implementation, pneumococcal disease (PD) remains an important cause of morbidity and mortality among the elderly in Japan, particularly since childhood pneumococcal conjugate vaccine (PCV) vaccination programme continues to alter the serotype PD distribution among the elderly. Recently, in the United States, PCV15/PCV20 were recommended for adults aged≥ 65 years and those aged 19–64 years with certain underlying conditions. In Japan, PCV15 is under the approval application process and PCV20 undergoing clinical trials, which has warranted the need in evaluating their value for money. Methods We conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios of PCV15/PCV20 vaccination programme compared to status quo from payers’ perspective. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. To reflect the situation of COVID-19 pandemic, epidemiological data from 2020 and beyond were used. Results Compared to the current vaccination programme, PCV20 vaccination programme gained more QALYs with less cost, while PCV15 vaccination programme cost¥ 35,020 (US $318, US $1=¥ 110) to gain an additional QALY. Replacing PPSV23 vaccination programme with PCV20 vaccination programme is cost-saving. One-way sensitivity analyses revealed that lower VE limits of PCVs against non-bacteremic pneumonia (NBP) have large impact to change the result from PCV20 vaccination programme dominated PPSV23 vaccination programme to PPSV23 vaccination programme dominated PCV20 vaccination programme. Conclusion In the COVID-19 era, replacing current PPSV23 with a single-dose PCV15-or PCV20 immunisation programme for 65-year-old adults in Japan is highly cost-effective, while the PCV 20 vaccination programme was observed to be more favourable.