Skip to main content
SpringerLink
Log in

The Cost Effectiveness of Pneumococcal Vaccination Strategies

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Pneumonia and influenza, combined, are the sixth leading causes of death in the US. The age-adjusted mortality rate for these diseases increased by 20% between 1979 and 1993, perhaps as a result of the emergence of multi-drug-resistant and penicillin-resistant strains of bacteria that cause pneumonia. Of the approximately $US23 billion annual cost of community-acquired pneumonia, pneumococcal pneumonia is currently estimated to account for up to $US18 billion.

Considering the clinical and economic consequences of pneumococcal disease, vaccination appears to be a valuable preventive strategy. However, despite Medicare coverage and the recommendations of the Advisory Committee on Immunisation Practices (ACIP), only 28% of elderly and high-risk patients received the pneumococcal vaccine in 1993.

This article reviews the epidemiology and economic factors that determine the cost effectiveness of pneumococcal vaccination strategies. The strategies are taken from a review of 10 published economic analyses of the pneumococcal vaccine. Cost savings and favourable cost-effectiveness ratios are associated with key factors that increase vaccination programme benefits by maximising averted direct medical costs as well as reducing vaccination programme costs, such as through public vaccination campaigns.

It appears that vaccination of the elderly, high-risk groups under 65 years of age, and patients with HIV infection or AIDS, is cost effective, if not cost saving, and that more widespread use of the vaccine, by means of large-scale vaccination campaigns, is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Centers for Disease Control and Prevention (CDC). Defining the public health impact of drug-resistant Streptococcus pneumoniae: report of working group. MMWR Morb Mortal Wkly Rep 1996; 45: 1–20

    Google Scholar 

  2. National Centers for Disease Control and Prevention (CDC). Mortality patterns: United States, 1993. MMWR Morb Mortal Wkly Rep 1996; 45: 161–79

    Google Scholar 

  3. National Centers for Disease Control and Prevention (CDC). Adult immunization: knowledge, attitudes, and practices. Dekalb and Fulton Counties, Georgia, 1988. MMWR Morb Mortal Wkly Rep 1988; 37: 657–61

    Google Scholar 

  4. National Centers for Disease Control and Prevention (CDC). Increasing pneumococcal vaccination rates among patients of a national health-care alliance: United States, 1993. MMWR Morb Mortal Wkly Rep 1995; 44: 741–4

    Google Scholar 

  5. Fedson DS. Influenza and pneumococcal vaccination of the elderly: newer vaccines and prospects for clinical benefits at the margin. Prev Med 1994; 23: 751–5

    Article  PubMed  CAS  Google Scholar 

  6. Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med 1995; 333: 1618–24

    Article  PubMed  CAS  Google Scholar 

  7. National Centers for Disease Control and Prevention (CDC). Influenza and pneumococcal vaccination coverage levels among persons aged >65 years: United States, 1973–1993. MMWR Morb Mortal Wkly Rep 1995; 44: 506–15

    Google Scholar 

  8. Mäkelä PH, Jokinen C, Pyhälä R, et al. Use of vaccines for respiratory infections: strategies for influenza and pneumococcal vaccines. J Infect Dis 1990; 70: 141–8

    Google Scholar 

  9. Morris A, Lang SDR. Vaccination against influenza and pneumococcal disease: are we doing our best? N Z Med J 1989; 102: 193–5

    PubMed  CAS  Google Scholar 

  10. Fedson DS, Henrichsen J, Mäkelä PH, et al. WHO recommendations on pneumococcal vaccination: immunization of elderly people with polyvalent pneumococcal vaccine. Infection 1989; 17: 437–41

    Article  PubMed  CAS  Google Scholar 

  11. Musher DM. Streptococcus pneumoniae. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious disease. 4th ed. New York: John Wiley & Sons, 1994: 1811–26

    Google Scholar 

  12. Lee CJ, Wang TR. Pneumococcal infection and immunization in children. Clin Rev Microb 1994; 20: 1–12

    Article  CAS  Google Scholar 

  13. Breiman RF, Spika JS, Navarro VJ, et al. Pneumococcal bacteremia in Charleston County, South Carolina: a decade later. Arch Intern Med 1990; 150: 1401–5

    Article  PubMed  CAS  Google Scholar 

  14. Forrester HL, Jahnigen DW, LaForce FM. Inefficacy of pneumococcal vaccine in high-risk population. Am J Med 1987; 83: 425–30

    Article  PubMed  CAS  Google Scholar 

  15. Pesola GR, Charles A. Pneumococcal bacteremia with pneumonia: mortality in acquired immunodeficiency syndrome. Chest 1992; 101: 150–5

    Article  PubMed  CAS  Google Scholar 

  16. Gable CB, Holzer SS, Engelhart L, et al. Pneumococcal vaccine: efficacy and associated cost savings. JAMA 1990; 264: 2910–5

    Article  PubMed  CAS  Google Scholar 

  17. Janoff EN, Breiman RF, Daley CL, et al. Pneumococcal disease during HIB infection. Ann Intern Med 1992; 117: 314–24.

    PubMed  CAS  Google Scholar 

  18. Fedson DS. Improving the use of pneumococcal vaccine through strategy of hospital-based immunization: a review of its rationale and implications. J Am Geriatr Soc 1985; 33: 142–50

    PubMed  CAS  Google Scholar 

  19. Graves EJ. Detailed diagnoses and procedures national hospital discharge survey, 1992: national center for health statistics. Vital Health Stat 13 1994; 118: 81

    Google Scholar 

  20. Advisory Committee on Immunisation Practices (ACIP). Recommendations of the immunization practices advisory committee pneumococcal polysaccharide vaccine. JAMA 1989; 261: 1265–7

    Article  Google Scholar 

  21. National Centers for Disease Control and Prevention (CDC). Successful strategies in adult immunization. MMWR Morb Mortal Wkly Rep 1991; 40: 700–9

    Google Scholar 

  22. Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis of randomized controlled trials. Arch Intern Med 1994; 154: 2666–77

    Article  PubMed  CAS  Google Scholar 

  23. Fedson DS. Clinical practice and public policy for influenza and pneumococcal vaccination of the elderly. Clin Geriatr Med 1992; 8(1): 183–99

    PubMed  CAS  Google Scholar 

  24. Fiebach N, Beckett W. Prevention of respiratory infections in adults: influenza and pneumococcal vaccine. Arch Intern Med 1994; 154: 2545–57

    Article  PubMed  CAS  Google Scholar 

  25. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453–9

    Article  PubMed  CAS  Google Scholar 

  26. Sims RV, Steinmann WC, McConville JH, et al. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med 1988; 108: 653–7

    PubMed  CAS  Google Scholar 

  27. Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993; 270: 1826–31

    Article  PubMed  CAS  Google Scholar 

  28. Hirshmann JV, Lipsky BA. The pneumococcal vaccine after 15 years of use. Arch Intern Med 1994; 154: 373–7

    Article  Google Scholar 

  29. LaForce FM. Adult immunizations: are they worth the trouble? J Gen Intern Med 1990; 5: S57–61

    Article  PubMed  CAS  Google Scholar 

  30. Fedson DS, Plotkin SA, Mortimer EA. Pneumococcal vaccine. Vaccine 1988; 13: 271

    Google Scholar 

  31. Simberkoff MS. Pneumococcal vaccination in the prevention of community-acquired pneumonia: a skeptical view of cost-effectiveness. Semin Respir Infect 1993; 8: 294–9

    PubMed  CAS  Google Scholar 

  32. Levy E. Evaluation socio-économique d’un vaccin contre l’infection pneumococcique. Rev Epidemiol Sante Publique 1981; 29: 133–53

    PubMed  CAS  Google Scholar 

  33. U.S. Congress, Office of Technology Assessment. A review of selected federal vaccine and immunization policies: based on case studies of pneumococcal vaccine. Washington, DC: Government Printing Office, 1979

    Google Scholar 

  34. Patrick KM, Woolley FR. A cost-benefit analysis of immunization for pneumococcal pneumonia. JAMA 1981; 245: 473–7

    Article  PubMed  CAS  Google Scholar 

  35. Ament AJ, Sprenger M, Botman MJ, et al. Kosten-batenanalyse van vaccinatie tegen pneumokokkenpneumonie. Ned Tijdschr Geneeskd 1986; 130: 407–10

    PubMed  CAS  Google Scholar 

  36. Fedson DS, Harward MP, Reid RA, et al. Hospital-based pneumococcal immunization: epidemiologic rationale from the Shenandoah study. JAMA 1990; 264: 1117–22

    Article  PubMed  CAS  Google Scholar 

  37. Holzer SS, Gable CB, Friedman RB. Cost-effectiveness of pneumococcal vaccine: implications for managed care. J Res Pharm Econ 1993; 5(1): 79–95

    Google Scholar 

  38. U.S. Congress, Office of Technology Assessment. Update of federal activities regarding the use of pneumococcal vaccine: a technical memorandum. Washington, DC: Government Printing Office, 1984

    Google Scholar 

  39. Rose DN, Schechter CB, Sacks HS. Influenza and pneumococcal vaccination of HIV-infected patients: a policy analysis. Am J Med 1993; 94: 160–8

    Article  PubMed  CAS  Google Scholar 

  40. US Bureau of Labor Statistics. Consumer price index. Washington, DC: US Department of Labor, 1996

    Google Scholar 

  41. Federal Reserve. Statistical Release. Foreign Exchange Rate 1/11/96. Washington, DC: US Federal Researve, 1996

    Google Scholar 

  42. Healthcare Financing Administration (HCFA) Bureau of Data Management and Strategy. FY95 Medicare Provider Analysis and Review (MEDPAR) File. Baltimore: HCFA, Jun 1995

    Google Scholar 

  43. St. Anthony’s DRG Guidebook, 1995. Reston (VA): St. Anthony Publishing, 1994: 42

  44. Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 1992; 146: 473–81

    CAS  Google Scholar 

  45. Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford Press, 1996

    Google Scholar 

  46. Jimenez FJ, Guallar P, Rubio C, et al. Cost-effectiveness analysis of pnemococcal vaccination in the elderly Spanish population. Br J Med Econ 1996; 10: 193–202

    Google Scholar 

  47. Rubio PP, Morales PG, Sanmarti LS. Cost effectiveness of pnemococcal vaccination in Catalonia. Rev Esp Salud Publica 1995; 69(5): 409–17

    Google Scholar 

  48. Healthcare Financing Administration (HCFA) Office of Managed Care. TEFRA Risk HMOs/CMPS. Baltimore: HCFA, Mar 1996

    Google Scholar 

  49. Healthcare Financing Administration (HCFA) 1995 Statistics. Washington, DC: US Department of Health and Human Services, 1995

  50. National Centers for Disease Control and Prevention (CDC). Prevention and managed care: opportunities for managed care organizations, purchasers of health care, and public health agencies. JAMA 1996; 275: 26–9

    Article  Google Scholar 

  51. Fedson DS. Influenza and pneumococcal immunization strategies for physicians. Chest 1987; 91: 436–43

    Article  PubMed  CAS  Google Scholar 

  52. McBean AM, Babish JD, Prihoda R. The utilization of pneumococcal polysaccharide vaccine among elderly Medicare beneficiaries, 1985–1988. Arch Intern Med 1991; 151: 2009–16

    Article  PubMed  CAS  Google Scholar 

  53. Foundation for accountability. Accountability Action 1996; 1(1): 9

    Google Scholar 

  54. General Accounting Office (GAO). Immunization: HHS could do more to increase vaccination among older adults. Washington, DC: GAO/PEMD-95-14, 1995

    Google Scholar 

  55. Quick RE, Hoge CW, Hamilton DJ, et al. Underutilization of pneumococcal vaccine in nursing homes in Washington State: report of a serotype-specific outbreak and a survey. Am J Med 1993; 94: 149–52

    Article  PubMed  CAS  Google Scholar 

  56. Fedson DS, Wajda A, Nicol JP, et al. The old man’s friend [letter]. Lancet 1993; 342: 561

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Outcomes Research, US Pharmaceuticals Group, Pfizer Inc., New York, New York, USA

    Carol B. Gable

  2. Health Economics, PAREXEL/S&FA, Alexandria, Virginia, USA

    Marc Botteman & Karen Joy

  3. Force Ten Partners, Reston, Virginia, USA

    Gale Savage

Authors
  1. Carol B. Gable
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Botteman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gale Savage
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Joy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carol B. Gable.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gable, C.B., Botteman, M., Savage, G. et al. The Cost Effectiveness of Pneumococcal Vaccination Strategies. Pharmacoeconomics 12, 161–174 (1997). https://doi.org/10.2165/00019053-199712020-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199712020-00006

Keywords

Search

Navigation