Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States
Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States
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DOI：
10.1007/s11606-016-3651-0
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发表时间：
2016-08-01
影响因子：
5.7
通讯作者：
Pilishvili, Tamara
中科院分区：
文献类型：
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作者：
Stoecker, Charles;Kim, Lindsay;Pilishvili, Tamara
最近公布的一项随机对照试验结果表明，13价肺炎球菌结合疫苗（PCV13）对成人疫苗型非菌源性肺炎有效。我们研究了将PCV13加入免疫实践咨询委员会（ACIP）成人免疫接种计划的增量成本效益。我们使用了一个概率模型来跟踪50岁、60岁和65岁的人群。我们对健康和高危成人分别使用疫苗接种覆盖率和疾病发病率数据。确定了每种潜在疫苗接种策略的增量成本-效果比。在基本情况下，我们的模型表明，在65岁时添加PCV13或在65岁时用PCV13替代23价肺炎球菌多糖疫苗（PPSV23）比在50岁或60岁时添加PCV13更物有所值。在考虑了儿童免疫计划中额外6年的群体保护后，我们发现添加PCV13取代PPSV23占主导地位。对于2013年的65岁人群，在65岁时将PCV13添加到计划中的成本为每个质量调整生命年（QALY）增加62,065美元，经过6年的预期群体保护后，这一成本上升到272,621美元。在短期内，为成人增加一剂PCV13疫苗的成本效益比似乎与其他疫苗接种干预措施相当，尽管预期的儿童免疫接种计划的群体保护可能会在短短几年后显著增加每个QALY的成本。
Recently released results from a randomized controlled trial have shown that 13-valent pneumococcal conjugate vaccine (PCV13) is efficacious against vaccine-type nonbacteremic pneumonia in adults.We examined the incremental cost-effectiveness of adding PCV13 to the Advisory Committee on Immunization Practices (ACIP) adult immunization schedule.We used a probabilistic model following cohorts of 50-, 60-, or 65-year-olds. We used separate vaccination coverage and disease incidence data for healthy and high-risk adults. Incremental cost-effectiveness ratios were determined for each potential vaccination strategy.In the base case scenario, our model indicated that adding PCV13 at age 65 or replacing 23-valent pneumococcal polysaccharide vaccine (PPSV23) at age 65 with PCV13 provided more value for money than adding PCV13 at ages 50 or 60. After projections of six additional years of herd protection from the childhood immunization program were incorporated, we found adding PCV13 dominated replacing PPSV23. For a cohort of 65-year-olds in 2013, the cost of adding PCV13 at age 65 to the schedule was $62,065 per quality-adjusted life year (QALY) gained, which rose to $272,621 after 6 years of projected herd protection.The addition of one dose of PCV13 for adults appears to have a cost-effectiveness ratio comparable to other vaccination interventions in the short run, though anticipated herd protection from the childhood immunization program may dramatically increase the cost per QALY after only a few years.