The 23-Valent Pneumococcal Polysaccharide Vaccine. Part II. A Cost-Effectiveness Analysis for Invasive Disease in the Elderly in England and Wales

Abstract

The 23-valent pneumococcal polysaccharide vaccine (PPV) has been available for a number of years and is recommended for high-risk categories. Relatively immunocompetent elderly people are not included in this group, although their probability of getting invasive pneumococcal infection is high. The objective of this study was to assess whether vaccinating all elderly people over 65 years of age was a cost-effective policy for England and Wales. The analysis was performed comparing the cost and health effects produced by vaccination, to what would have been occurred if vaccination were not introduced. A decision analysis model was used in order to predict health outcomes under different vaccination scenarios. Unit costs were applied to the outcome and the cost per life-year gained was calculated. Sensitivity analysis was performed to allow for uncertain parameters to vary. The current UK recommendation does not appear to be the most cost-effective strategy due to the low level of efficacy of the vaccine in high-risk groups (HRG) and their shorter life expectancy. Routine vaccination of all elderly appears to be more cost-effective. These results are, nevertheless, very much dependent on the uncertainties around vaccine efficacy estimates, which appear to be still present, especially in HRG, and on the number of hospitalisations and deaths attributable to invasive pneumococcal disease (IPD).

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References

  1. 1.

    Brown PD, Lerner SA. Community-acquired pneumonia. Lancet 1998; 352: 1295-1302.

    PubMed  Google Scholar 

  2. 2.

    Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalisation: 5-year prospective study. Rev Inf Dis 2002; 11: 586-599.

    Google Scholar 

  3. 3.

    Block SL. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J 1997; 16: 449-456.

    PubMed  Google Scholar 

  4. 4.

    Gwaltney Jr JM. Acute community-acquired sinusitis. Clin Inf Dis 1996; 23: 1209-1223.

    Google Scholar 

  5. 5.

    Obaro SK, Monteil MA, Henderson DC. Fortnightly review: The pneumococcal problem. Br Med J 1996; 312: 1521.

    Google Scholar 

  6. 6.

    Ament A, Baltussen R, Duru G, Rigaud-Bully C. Cost-effectiveness of pneumococcal vaccination of older people: A study in 5 European countries. Clin Inf Dis 2000; 31: 444-450.

    Google Scholar 

  7. 7.

    Smith MD, Stuart J, Andrews NJ, Tefler Brunton WA, Cartwright KA. Invasive pneumococcal infection in South and West England. Epidemiol Infect 1998; 120: 117-123.

    PubMed  Google Scholar 

  8. 8.

    Laurichesse H, Grimaud O, Waight P, Johnson AP, George R, Miller E. Pneumococcal bacteremia and meningitis in England and Wales, 1993 to 1995. Commun Dis Public Health 1998; 1: 22-27.

    PubMed  Google Scholar 

  9. 9.

    Salisbury DM, Begg NT. Immunisation against infectious disease. Bicentenary Edition ed. London: HMSO, 1996.

    Google Scholar 

  10. 10.

    Kyaw MH, Wayne B, Chalmers J, Jones IG, Campbell H. Influenza and pneumococcal vaccine distribution and use in primary care and hospital settings in Scotland: Coverage, practice and policies. Epidemiol Infect 2002; 128: 445-455.

    PubMed  Google Scholar 

  11. 11.

    Fedson DS. Pneumococcal vaccination in the United States and 20 other developed countries, 1981–1996. Clin Inf Dis 1998; 26: 1117-1123.

    Google Scholar 

  12. 12.

    Postma MJ, Heijnen ML, Jager JC. Cost-effectiveness analysis of pneumococcal vaccination for elderly individuals in The Netherlands. Pharmacoeconomics 2001; 19: 215-222.

    PubMed  Google Scholar 

  13. 13.

    Pepper PV, Owens DK. Cost-effectiveness of the pneumococcal vaccine in healthy younger adults. Med Decis Making 2002; 22(5 Suppl): S45-S57.

    PubMed  Google Scholar 

  14. 14.

    Nichol KL, Baken L, Wuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med 1999; 159(Nov 8): 2437-2442.

    PubMed  Google Scholar 

  15. 15.

    Weaver M, Krieger J, Castorina J, Walls M, Ciske S. Cost-effectiveness of combined outreach for the pneumococcal and influenza vaccines. Arch Intern Med 2001; 161(Jan 8): 111-120.

    PubMed  Google Scholar 

  16. 16.

    Gable CB, Holzer SS, et al. Pneumococcal vaccine — Efficacy and associated cost savings. JAMA 1990; 264: 2910-2915.

    PubMed  Google Scholar 

  17. 17.

    Rose DN, Schechter CB, Sacks HS. Influenza and pneumococcal vaccination of HIV-infected patients: A policy analysis. Am J Med 1993; 94: 160-168.

    PubMed  Google Scholar 

  18. 18.

    Sisk J, Moskowitz A, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997; 278: 1333-1339.

    PubMed  Google Scholar 

  19. 19.

    Fine MJ, Smith MA, et al. Efficacy of pneumococcal vaccination in adults — a meta analysis of randomized controlled trials. Arch Intern Med 1994; 154: 2666-2677.

    PubMed  Google Scholar 

  20. 20.

    Rubins JB, Alter M, Loch J, Jano. EN. Determination of antibody responses of elderly adults to all 23 capsular polysaccharide after pneumococcal vaccination. Infect Immun 1999; 67(11): 5979-5984.

    PubMed  Google Scholar 

  21. 21.

    French N, Nakiyingi J, et al. 23-valent pneumococcal polysaccharide vaccine in HIV-1 infected Ugandan adults: Double blind, randomised and placebo controlled trial. Lancet 2000; 355: 2106-2111.

    PubMed  Google Scholar 

  22. 22.

    McCormick A, Fleming D, Charlton J. Morbidity Statistics from General Practice, Fourth National Survey 1991–92, MB5. London: HMSO, 2002.

    Google Scholar 

  23. 23.

    Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the panel of cost-effectiveness in health and medicine. JAMA 1996; 276: 1253-1258.

    PubMed  Google Scholar 

  24. 24.

    Policy appraisal and health. London: Department of Health, 1995.

  25. 25.

    Herva E, Luotonen J, Timonen M, Sibakov M, Karma P, Makela PH. The effect of polyvalent pneumococcal polysaccharide vaccine on nasopharyngeal and nasal carriage of Streptococcus pneumoniae. Scand J Infect Dis 1980; 12: 97-100.

    PubMed  Google Scholar 

  26. 26.

    Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes, 2nd edn. Oxford: OUP, 1997.

    Google Scholar 

  27. 27.

    Miller E, Waight P, Efstratiou A, Brisson M, Johnson A, George R. Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996–1998. Acta Paediatr Suppl 2000; 435: 11-16.

    Google Scholar 

  28. 28.

    Melegaro A, Edmunds WJ. The 23-valent pneumococcal polysaccharide vaccine. Part I. Efficacy of PPV in the elderly: A comparison of meta-analyses. Eur J Epidemiol 2004; 19: 357-367.

    Google Scholar 

  29. 29.

    Ortqvist A. Pneumococcal vaccination: Current and future issues. Eur Resp J 2001; 18: 184-195.

    Google Scholar 

  30. 30.

    Shapiro ED, Berg AT, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453-1460.

    PubMed  Google Scholar 

  31. 31.

    Rubins JB, Puri AKG, et al. Magnitude, duration, quality, and function of pneumococcal vaccine responses in elderly adults. J Infect Dis 1998; 178: 431-440.

    PubMed  Google Scholar 

  32. 32.

    Fedson D, Musher D, Eskola J. Pneumococcal vaccine. In: Plotkin S, Orenstein W (eds), Vaccines. Philadelphia: W.B. Saunders Company, 1999; 553-607.

    Google Scholar 

  33. 33.

    Netten A, Rees THG. Unit Costs of Health and Social Care 2001. PSSRU-University of Kent, 2000.

  34. 34.

    British National Formulary, 2000.

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Melegaro, A., Edmunds, W.J. The 23-Valent Pneumococcal Polysaccharide Vaccine. Part II. A Cost-Effectiveness Analysis for Invasive Disease in the Elderly in England and Wales. Eur J Epidemiol 19, 365–375 (2004). https://doi.org/10.1023/B:EJEP.0000024752.48929.bd

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  • Cost-effectiveness
  • Elderly
  • High-risk
  • Polysaccharide pneumococcal vaccine