Higher-Valency Pneumococcal Conjugate Vaccines: An Exploratory Cost-Effectiveness Analysis in U.S. Seniors.
Higher-Valency Pneumococcal Conjugate Vaccines: An Exploratory Cost-Effectiveness Analysis in U.S. Seniors.
复制标题
DOI：
10.1016/j.amepre.2021.01.023
复制
发表时间：
2021-07
影响因子：
5.5
通讯作者：
Zimmerman RK
中科院分区：
文献类型：
--
作者：
Smith KJ;Wateska AR;Nowalk MP;Lin CJ;Harrison LH;Schaffner W;Zimmerman RK
13价肺炎球菌结合疫苗（PCV 13）在年龄≥65岁的非免疫功能低下成人中的使用存在争议。更高效价的结合疫苗（PCV 15和PCV 20）正在开发中;其在老年人中的潜在成本效益尚不清楚，特别是考虑到儿童疫苗接种的潜在间接（群体免疫）效应时。马尔可夫模型估计的成本效益，目前美国的建议和替代战略，使用目前可用的和正在开发的PCV在老年人。另外，将使用添加7种最常见致病性非PCV 13肺炎球菌血清型的假想疫苗（HypoPCV 20）的策略与其他策略进行比较。进行了敏感性分析，并审查了替代方案。于二零二零年收集数据并进行分析。在仅考虑现有和正在开发的疫苗的分析中，与基线假设（血清型有效性相同且无儿童疫苗接种间接影响）下的当前美国建议相比，单独使用PCV 20的成本为172，491美元/质量调整生命年（QALY）。PCV 15策略成本更高，效果更差。当假定PCV 13/PCV 20对肺炎球菌血清型3无效（存在争议）而PCV 15完全有效时，PCV 15的成本为237，431美元/QALY。考虑到间接影响，PCV 15或PCV 20成本> 449，000美元/QALY。当在基线假设下添加HypoPCV 20时，HypoPCV 20成本为139，348美元/QALY，在替代假设下结果变化不大。在这项探索性分析中，无论血清型有效性假设如何，开发中PCV在老年人中可能在经济上不合理，特别是考虑到儿童使用这些疫苗的潜在间接影响时。含有儿童疫苗中不含的高风险血清型的成人疫苗可能更有希望。
Use of the 13-valent pneumococcal conjugate vaccine (PCV13) in non-immunocompromised adults aged ≥65 years is controversial. Higher-valency conjugate vaccines (PCV15 and PCV20) are under development; their potential cost effectiveness in older adults is unknown, particularly when potential indirect (herd immunity) effects from childhood vaccination are considered. A Markov model estimated the cost effectiveness of current U.S. recommendations and alternative strategies using currently available and in-development PCVs in seniors. Separately, strategies using a hypothetical vaccine (HypoPCV20) adding the 7 most common disease-causing non-PCV13 pneumococcal serotypes were compared with the other strategies. Sensitivity analyses were performed and alternative scenarios examined. Data were gathered and analyses performed in 2020. In analyses considering only existing and in-development vaccines, sole PCV20 use cost $172,491/quality-adjusted life-year (QALY) gained compared with current U.S. recommendations under baseline assumptions (equal serotype effectiveness and no childhood vaccination indirect effects). PCV15 strategies were more costly and less effective. When PCV13/PCV20 were assumed ineffective against pneumococcal serotype 3 (a point of controversy) and PCV15 was fully effective, PCV15 cost $237,431/QALY gained. With indirect effects considered, PCV15 or PCV20 cost >$449,000/QALY gained. When adding HypoPCV20 under baseline assumptions, HypoPCV20 cost $139,348/QALY gained and results changed little under alternative assumptions. In this exploratory analysis, in-development PCVs may be economically unreasonable in older adults, regardless of serotype effectiveness assumptions, particularly when considering potential indirect effects from use of those vaccines in children. Adult vaccines containing higher-risk serotypes not contained in childhood vaccines may be more promising.
登录
查看更多内容
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：
5.5
作者：
Thompson, Allison;Lamberth, Erik;Watson, Wendy
通讯作者：
Watson, Wendy
影响因子：
120.7
作者：
Jackson, L;Benson, P;Williams, WW
通讯作者：
Williams, WW
影响因子：
39.2
作者：
Sisk, JE;Whang, W;Whitney, CG
通讯作者：
Whitney, CG
影响因子：
158.5
作者：
Bonten, M. J. M.;Huijts, S. M.;Grobbee, D. E.
通讯作者：
Grobbee, D. E.