Pneumococcal infection in the elderly: cost-effectiveness of vaccination to reduce demographic losses
Aim . To assess cost-effectiveness for vaccinating people ≥60 years against pneumococcal infection. Material and methods . Markov modeling was conducted using epidemiological data for the Russian Federation for people aged ≥60 years. The cost-effectiveness of monovaccination with a 23-valent polysaccharide vaccine (PPV23), sequential immunization with a 13-valent conjugate vaccine (PCV13) followed by PPV23 one year later, and vaccination with a 20-valent conjugate vaccine (PCV20) were assessed. The analysis was conducted from the perspective of society as a whole and from the healthcare system. The study time horizon was 10 years. Vaccine costs were analyzed based on registered prices, including VAT. Costs and quality-adjusted life expectancy were discounted by 3% per year. A sensitivity analysis assessed the cost-effectiveness of changing the price of PCV20 by 15% and reducing the time horizon to 5 years. Results . PCV20 vaccination reduces the incidence of pneumococcal infection compared to monovaccination with PPV23 and sequential PCV13/PPV23 immunization. When vaccinating individuals ≥60 years, the incremental cost per additional quality-adjusted life year (QALY) from a societal perspective would be RUB3,684,400, RUB2,087,300, and RUB1,385,600 for PPV23, PCV13/PPV23, and PCV20 vaccination, respectively. When analyzed from a healthcare system perspective, the cost-effectiveness ratios are RUB3,908,100/QALY, RUB2,288,700/ QALY, and RUB1,585,300/QALY for vaccination with PPV23, PCV13/ PPV23, and PCV20, respectively. A sensitivity analysis demonstrated the reliability of the obtained data. Conclusion . Vaccination of Russian people aged ≥60 years with PCV20 provides the greatest reduction in pneumococcal infection incidence and is highly cost-effective compared to PPV23 vaccination and is cost-effective compared to sequential PCV13/PPV23 vaccination. All vaccination options are cost-effective compared to no vaccination.