Cost-Effectiveness of Newly Recommended Pneumococcal Vaccination Strategies in Older Underserved Minority Adults in the USA.
Cost-Effectiveness of Newly Recommended Pneumococcal Vaccination Strategies in Older Underserved Minority Adults in the USA.
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新建议的肺炎球菌疫苗接种策略的成本效益是美国老年人服务不足的少数民族成年人的成本效益。
DOI：
10.1007/s40121-022-00669-x
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发表时间：
2022-08
影响因子：
5.4
通讯作者：
Zimmerman, Richard K.
中科院分区：
文献类型：
--
作者：
Smith, Kenneth J.;Wateska, Angela R.;Nowalk, Mary Patricia;Lin, Chyongchiou J.;Harrison, Lee H.;Schaffner, William;Zimmerman, Richard K.
美国针对65岁或65岁以上成年人的肺炎球菌疫苗接种建议最近发生了变化，可以选择20价肺炎球菌结合疫苗(PCV20)，也可以选择15价结合疫苗(PCV15)，然后在一年后接种23价多糖疫苗(PPSV23)。服务不足的少数族裔成年人患肺炎球菌病的风险更高。马尔科夫决策分析模型估计了新采用的普通人群肺炎球菌疫苗接种策略在老年、服务不足的少数族裔成年人中的增量成本效益。该模型研究了假想的65岁的美国黑人队列(作为服务不足的少数族裔的代理)和接受PCV20或PCV15/PPSV23疫苗接种或不接种疫苗的非黑人队列。主要结果指标包括每获得质量调整生命年(QALY)的增量成本效益和肺炎球菌病的公共卫生结果。与非黑人人群相比，黑人人群患肺炎球菌病住院的风险更大。在黑人队列中，与不接种疫苗相比，人均PCV20战略总成本高出124%，而QALY增长0.00073，即每QALY增长169,540美元。与PCV20相比，PCV15/PPSV23的成本为535,797美元/QALY。在非黑人队列中，与未接种疫苗相比，PCV20的成本为210,529美元/QALY，PCV15/PPSV23的成本为728,423美元/QALY。疫苗效力的合理变化对PCV20策略结果的影响最小，并使PCV15/PPSV23更加不利。在更简单的单疫苗PCV20策略将绝对疫苗接种量增加10%的情况下，PCV20的成本效益变化最小，而在黑色队列中，PCV15/PPSV23的成本超过600万美元/QALY。在同时改变所有参数的概率敏感性分析中，当阈值低于500,000美元/QALY时，PCV15/PPSV23不太可能受到青睐。在黑人和非黑人老年人口中，使用PCV20的总体人口建议比PCV15/PPSV23更经济合理。如果使用单一疫苗会增加接种率，这在服务不足的人群中可能更有可能，那么使用PCV20就会变得更加有利。网上版载有补充材料，可在10.1007/s40121022-00669-x上查阅。
US pneumococcal vaccination recommendations for adults aged 65 years or older recently changed, with options for either 20-valent pneumococcal conjugate vaccine (PCV20) or the combination of 15-valent conjugate vaccine (PCV15) followed by 23-valent polysaccharide vaccine (PPSV23) 1 year later. Underserved minority adults are at higher risk for pneumococcal disease. A Markov decision analysis model estimated the incremental cost-effectiveness of the newly adopted general population pneumococcal vaccination strategies in older underserved minority adults. The model examined hypothetical 65-year-old US Black cohorts (serving as a proxy for underserved minorities) and non-Black cohorts receiving PCV20 or PCV15/PPSV23, or no vaccination. Main outcome measures included incremental cost-effectiveness per quality-adjusted life year (QALY) gained and pneumococcal disease public health outcomes. Black cohorts had a greater risk of pneumococcal disease hospitalization compared to non-Black cohorts. In Black cohorts, total per person PCV20 strategy costs, compared to no vaccination, were $124 higher while gaining 0.00073 QALY, or $169,540/QALY gained. PCV15/PPSV23 cost $535,797/QALY compared to PCV20. In the non-Black cohort, PCV20 cost $210,529/QALY gained compared to no vaccination and PCV15/PPSV23 cost $728,423/QALY. Plausible variation of vaccine effectiveness minimally affected PCV20 strategy results and made PCV15/PPSV23 more unfavorable. In scenarios where the simpler one-vaccine PCV20 strategy increased absolute vaccine uptake by 10%, PCV20 cost-effectiveness changed minimally while PCV15/PPSV23 cost in excess of $6 million/QALY in the Black cohort. In probabilistic sensitivity analyses that varied all parameters simultaneously, PCV15/PPSV23 was unlikely to be favored at thresholds less than $500,000/QALY gained. General population recommendations for PCV20 use are substantially more economically reasonable in Black and non-Black older adult populations than PCV15/PPSV23. If using a single vaccine increases uptake, which is potentially more likely in the underserved, then PCV20 use becomes even more favorable. The online version contains supplementary material available at 10.1007/s40121-022-00669-x.
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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：
3.3
作者：
Nowalk, Mary Patricia;Wateska, Angela R.;Smith, Kenneth J.
通讯作者：
Smith, Kenneth J.
影响因子：
5.5
作者：
Wateska, Angela R.;Nowalk, Mary Patricia;Smith, Kenneth J.
通讯作者：
Smith, Kenneth J.
影响因子：
15.8
作者：
Lawrence H;Pick H;Baskaran V;Daniel P;Rodrigo C;Ashton D;Edwards-Pritchard RC;Sheppard C;Eletu SD;Litt D;Fry NK;Rose S;Trotter C;McKeever TM;Lim WS
通讯作者：
Lim WS
使用4个支柱实践转化计划来增加老年人的肺炎球菌免疫接种：一项聚类随机试验。
影响因子：
6.3
作者：
Zimmerman RK;Brown AE;Pavlik VN;Moehling KK;Raviotta JM;Lin CJ;Zhang S;Hawk M;Kyle S;Patel S;Ahmed F;Nowalk MP
通讯作者：
Nowalk MP