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).
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Brown PD, Lerner SA. Community-acquired pneumonia. Lancet 1998; 352: 1295-1302.
Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalisation: 5-year prospective study. Rev Inf Dis 2002; 11: 586-599.
Block SL. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J 1997; 16: 449-456.
Gwaltney Jr JM. Acute community-acquired sinusitis. Clin Inf Dis 1996; 23: 1209-1223.
Obaro SK, Monteil MA, Henderson DC. Fortnightly review: The pneumococcal problem. Br Med J 1996; 312: 1521.
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.
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.
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.
Salisbury DM, Begg NT. Immunisation against infectious disease. Bicentenary Edition ed. London: HMSO, 1996.
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.
Fedson DS. Pneumococcal vaccination in the United States and 20 other developed countries, 1981–1996. Clin Inf Dis 1998; 26: 1117-1123.
Postma MJ, Heijnen ML, Jager JC. Cost-effectiveness analysis of pneumococcal vaccination for elderly individuals in The Netherlands. Pharmacoeconomics 2001; 19: 215-222.
Pepper PV, Owens DK. Cost-effectiveness of the pneumococcal vaccine in healthy younger adults. Med Decis Making 2002; 22(5 Suppl): S45-S57.
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.
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.
Gable CB, Holzer SS, et al. Pneumococcal vaccine — Efficacy and associated cost savings. JAMA 1990; 264: 2910-2915.
Rose DN, Schechter CB, Sacks HS. Influenza and pneumococcal vaccination of HIV-infected patients: A policy analysis. Am J Med 1993; 94: 160-168.
Sisk J, Moskowitz A, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997; 278: 1333-1339.
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.
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.
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.
McCormick A, Fleming D, Charlton J. Morbidity Statistics from General Practice, Fourth National Survey 1991–92, MB5. London: HMSO, 2002.
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.
Policy appraisal and health. London: Department of Health, 1995.
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.
Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes, 2nd edn. Oxford: OUP, 1997.
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.
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.
Ortqvist A. Pneumococcal vaccination: Current and future issues. Eur Resp J 2001; 18: 184-195.
Shapiro ED, Berg AT, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453-1460.
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.
Fedson D, Musher D, Eskola J. Pneumococcal vaccine. In: Plotkin S, Orenstein W (eds), Vaccines. Philadelphia: W.B. Saunders Company, 1999; 553-607.
Netten A, Rees THG. Unit Costs of Health and Social Care 2001. PSSRU-University of Kent, 2000.
British National Formulary, 2000.
About this article
Cite this article
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
- Polysaccharide pneumococcal vaccine