Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions
Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions
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DOI：
10.1016/j.vaccine.2013.10.024
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发表时间：
2013-12-05
期刊：
影响因子：
5.5
通讯作者：
Moore, Matthew R.
中科院分区：
文献类型：
--
作者：
Cho, Bo-Hyun;Stoecker, Charles;Moore, Matthew R.
背景：2012年6月，一剂13价肺炎球菌结合疫苗（PCV13）被添加到免疫功能低下成人的推荐中，这些成人以前只推荐接种23价肺炎球菌多糖疫苗（PPSV23）。PCV13可能更有效，尽管它覆盖的致病菌株较少。目的：我们研究了在2012年前推荐的PPSV23的基础上增加一剂PCV13的增量成本效益，用于患有4种免疫功能低下疾病的成人，这些疾病有肺炎球菌疾病的风险增加：HIV/AIDS、血液学癌症、实体器官移植和终末期肾脏疾病。方法：我们使用了一个概率模型，跟踪了302397名免疫功能低下的成年人。我们使用了疫苗接种覆盖率和疾病发病率数据，这些数据是针对每种免疫损害情况的。关于PPSV23和PCV13疫苗有效性的假设是基于在hiv感染成人中进行的两项随机对照试验和几项观察性研究。由于没有在其他免疫功能低下人群中进行过此类研究，因此我们对这些人群中疫苗的相对有效性做了进一步的假设。确定每种情况和所有4组的成本-效果比。结果：我们的模型表明，在美国，为患有4种免疫功能低下疾病的成年人增加一剂PCV13疫苗将花费1600万美元（2009年的美元），但从社会角度来看，每个队列可以节省2100万美元。这些节省主要来自于终末期肾病患者医疗费用的降低。该剂量PCV13可预防57例侵袭性肺炎球菌病，619例住院全因肺炎，避免93例死亡，并为每个队列节省1360个质量调整生命年。结论：在先前推荐的PPSV23剂量的基础上增加一剂PCVI3可能会减少选定免疫功能低下的成年人的疾病和成本。(C) 2013 Elsevier Ltd.版权所有。
Background: In June, 2012 a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) was added to the recommendation for immunocompromised adults who were previously recommended to receive only 23-valent pneumococcal polysaccharide vaccine (PPSV23). PCV13 may be more effective, though it covers fewer disease-causing strains.Objective: We examined the incremental cost-effectiveness of adding one dose of PCV13 to the pre-2012 recommendation of PPSV23 for adults with 4 immunocompromising conditions who are at increased risk of pneumococcal disease: HIV/AIDS, hematologic cancer, solid organ transplants, and end stage renal disease.Methods: We used a probabilistic model following a single cohort of 302,397 immunocompromised adults. We used vaccination coverage and disease incidence data specific to each immunocompromising condition. Assumptions about PPSV23 and PCV13 vaccine effectiveness were based on two randomized controlled trials and several observational studies conducted among HIV-infected adults. Because no such studies have been conducted among other immunocompromised populations, we made further assumptions about the relative vaccine effectiveness in those groups. Cost-effectiveness ratios were determined for each condition and for all 4 groups in total.Results: Our model indicated that adding one dose of PCV13 to adults in the United States with 4 immunocompromising conditions would cost $16 million (in 2009$) but provide off-setting savings of $21 million per cohort from the societal perspective. These savings come largely from decreased medical costs among adults with end stage renal disease. This dose of PCV13 would prevent 57 cases of invasive pneumococcal disease, 619 cases of hospitalized all-cause pneumonia, avert 93 deaths, and save 1360 quality adjusted life years per cohort.Conclusion: The addition of one dose of PCVI3 to the previously recommended PPSV23 doses for adults with selected immunocompromised conditions potentially reduces both disease and costs. (C) 2013 Elsevier Ltd. All rights reserved.