Cost-effectiveness of an in-development adult-formulated pneumococcal vaccine in older US adults.
Cost-effectiveness of an in-development adult-formulated pneumococcal vaccine in older US adults.
复制标题
正在开发的成人配方肺炎球菌疫苗对美国老年人的成本效益。
DOI：
10.1016/j.vaccine.2023.06.007
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发表时间：
2023
期刊：
影响因子：
5.5
通讯作者：
Smith,KennethJ
中科院分区：
文献类型：
--
作者：
Wateska,AngelaR;Nowalk,MaryPatricia;Lin,ChyongchiouJ;Harrison,LeeH;Schaffner,William;Zimmerman,RichardK;Smith,KennethJ
CDC对老年人的肺炎球菌疫苗接种建议现在包括15价或20价肺炎球菌结合疫苗（PCV 15/PCV 20）。然而，根据成人肺炎球菌疾病流行病学配制的正在开发的21价疫苗（PCV 21）可以大幅增加致病性肺炎球菌血清型的覆盖率，特别是在风险更大的黑人老年人中。与目前推荐的老年人疫苗相比，PCV 21的潜在公共卫生影响和成本效益尚不清楚。方法马尔可夫决策模型比较了目前的肺炎球菌疫苗接种建议，PCV 21使用黑人和非黑人65岁的队列。CDC活动细菌核心监测数据告知人群和特定类型肺炎球菌疾病的风险。使用德尔菲小组估计和临床试验数据估计疫苗有效性，敏感性分析存在差异。检查了PCV 15儿童疫苗接种对成人疾病的潜在间接影响。在敏感性分析中，所有模型参数单独和共同变化。还研究了PCV 21有效性下降和潜在COVID-19大流行影响的情景。结果在黑人队列中，PCV 21策略的成本为88，478美元/质量调整生命年（QALY），没有儿童PCV 15间接影响，成本为97，952美元/QALY。非黑人队列中PCV 21的成本为127，436美元/QALY，无儿童期PCV 15影响，为141，358美元/QALY。目前的推荐策略在经济上是不利的，无论是人口还是间接的儿童疫苗接种效果。在敏感性分析和替代方案中，支持使用PCV 21的结果是稳健的。结论：与目前推荐的老年人肺炎球菌疫苗相比，正在开发的PCV 21疫苗可能在经济和临床上是有利的。虽然PCV 21在黑人队列分析中更有利，但黑人和非黑人人群的结果在经济上都是合理的，突出了成人特异性肺炎球菌疫苗制剂的潜在重要性，并且在进一步调查之前，可能证明未来一般人群推荐PCV 21用于老年人。
Introduction CDC pneumococcal vaccination recommendations for older adults now include either 15-or 20-valent pneumococcal conjugate vaccine (PCV15/PCV20). However, an in-development 21-valent vaccine (PCV21), formulated based on adult pneumococcal disease epidemiology, could substantially increase coverage of disease-causing pneumococcal serotypes, particularly in Black older adults, who are at greater risk. The potential public health impact and cost-effectiveness of PCV21 compared to currently recommended vaccines in older adults is unclear. Methods A Markov decision model compared current pneumococcal vaccination recommendations to PCV21 use in Black and non-Black 65-year-old cohorts. CDC Active Bacterial Core surveillance data informed population and serotype-specific pneumococcal disease risk. Vaccine effectiveness was estimated using Delphi panel estimates and clinical trial data, with variation in sensitivity analyses. Potential indirect effects on adult disease from PCV15 childhood vaccination were examined. All model parameters were varied individually and collectively in sensitivity analyses. Scenarios with decreased PCV21 effectiveness and potential COVID-19 pandemic effects were also examined. Results In the Black cohort, the PCV21 strategy cost $88,478 per quality adjusted life-year (QALY) gained without and $97,952/QALY with childhood PCV15 indirect effects. PCV21 in the non-Black cohort cost $127,436/QALY gained without and $141,358/QALY with childhood PCV15 effects. Current recommendation strategies were economically unfavorable, regardless of population or indirect childhood vaccination effects. Results favoring PCV21 use were robust in sensitivity analyses and alternative scenarios. Conclusion An in-development PCV21 vaccine would likely be economically and clinically favorable compared to currently recommended pneumococcal vaccines in older adults. While PCV21 was more favorable in Black cohort analyses, results for both Black and non-Black populations were economically reasonable, highlighting the potential importance of adult-specific pneumococcal vaccine formulations and, pending further investigation, potentially justifying a future general population recommendation for PCV21 use in older adults.