Abstract
Objective: To analyse the direct medical costs and effectiveness of vaccinating adults aged between 18 and 64 years and elderly persons ≥65 years of age with the 23-valent pneumococcal polysaccharide vaccine.
Design and setting: This was a decision-analytic modelling study from the societal perspective in Belgium. The analysis compared ‘evaccination’ with ‘no vaccination and treatment’.
Methods: Calculations were based on the assumption that vaccination is as effective against all pneumococcal infections as it is against invasive pneumococcal disease. Data on the incidence of pneumococcal pneumonia and meningitis, frequency of hospitalisation, mortality rates and vaccine effectiveness were derived from the international literature. Costs were derived from analysis of historical data for cases of pneumococcal infection in Belgium.
Results: Vaccinating 1000 adults between the ages of 18 and 64 years gains approximately 2 life-years in comparison with the no vaccination option. However, to realise these additional health benefits requires additional costs of 11 800 European Currency Units (ECU; 1995 values) per life-year saved. Vaccinating 1000 elderly people (≥65 years) leads to >9 life-years gained as well as a small monetary benefit of ECU1250. An extensive sensitivity analysis did not greatly affect the results for the elderly population: vaccination in this age group always remained favourable, and thus it is clearly indicated from an economic point of view. A crucial assumption for both age groups is that the effectiveness of the vaccine holds for all pneumococcal pneumonia. It is clear that the results will become less favourable if this assumption is dropped.
Conclusions: Preventing pneumococcal infections by vaccination clearly benefits people’s health. Reimbursement can be recommended for the elderly group; however, more accurate epidemiological data are still needed to make decisions concerning routine pneumococcal vaccination in adults <65 years of age. Unfortunately, the issue of whether the effectiveness of the vaccine holds for all pneumococcal pneumonia is as yet unresolved in the medical literature.
Similar content being viewed by others
Notes
The age distribution is unknown.
All figures are rounded values given in Belgian francs.
References
Peetermans W, Bachez P, Peleman R, et al. Belgian consensus on pneumococcal vaccine. Acta Clin Belg 1996; 51 (5): 350–6
Centers for Disease Control. Recommendations of the Immunization Practices Advisory Committee: pneumococcal polysaccharide vaccine. MMWR Morb Mortal Wkly Rep 1989; 38: 64–8, 73–6
MacFarlane J. An overview of community-acquired pneumonia with lessons learned from the British Thoracic Society study. Semin Respir Infect 1994; 9 (3): 153–65
Musher DM. Infections caused by Streptococcus pneumonia: clinical spectrum, pathogenesis, immunity and treatment. Clin Infect Dis 1992; 14: 801–9
Fedson DS. Pneumococcal vaccination in the prevention of community-acquired pneumonia: an optimistic view of cost-effectiveness. Semin Respir Infect 1993; 8 (4): 285–93
Spika JS, Fedson DS, Facklam RR. Pneumococcal vaccination: controversies and opportunities. Infect Dis Clin North Am 1990; 4 (1): 11–27
Baltussen RMPM, Ament AJHA, Leidl RM. Economic aspects of vaccinating the elderly against pneumococcal pneumonia. Maastricht: University of Limburg, Department of Health Economics, 1996
Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med 1995; 333: 1618–24
Shann F. Modern vaccines: pneumococcus and influenza. Lancet 1990; 335: 898–901
Breiman RF, Spika JS, Navarro VJ, et al. Pneumococcal bacteremia in Charlestone County, South Carolina: a decade later. Arch Intern Med 1990; 150: 1401–5
Finch RG. Pneumococcus. In: Greenwood D, Slack RC, Peutherer JF, et al., editors. Medical microbiology. Edinburgh: Churchill Livingstone, 1992: 223–9
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
Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993; 270 (15): 1826–31
Forrester HL, Jahnigen DW, LaForce FM. Inefficacy of pneumococcal vaccine in a high-risk population. Am J Med 1987; 83: 425–30
Sims RV, Steinmann WC, McConville JH, et al. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med 1988; 108: 653–7
Farr BM, Johnston BL, Cobb DK, et al. Preventing pneumococcal bacteremia in patients at risk: results of a matched case-control study. Arch Intern Med 1995; 155: 2336–40
Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325 (21): 1453–60
Sisk JE, Riegelman RK. Cost effectiveness of vaccination against pneumococcal pneumonia: an update. Ann Intern Med 1986; 104: 79–86
Gable CB, Holzer SS, Engelhart L, et al. Pneumococcal vaccine: efficacy and associated cost savings. JAMA 1990; 264 (22): 2910–5
Patrick KM, Woolley FR. A cost-benefit analysis of immunization for pneumococcal pneumonia. JAMA1981; 245 (5): 473–7
Willems JS, Sanders CR, Riddiough MA, et al. Cost effectiveness of vaccination against pneumococcal pneumonia. N Engl J Med 1980; 303 (10): 553–9
Mäkelä PH, Jokinen C, Pyhälä R, et al. Use of vaccines for respiratory infections: strategies for influenza and pneumococcal vaccines. Scand J Infect Dis 1990; 70 Suppl.: 141–8
Sanford J, Gilbert D, Gerberding J, et al. The Sanford guide to antimicrobial therapy: Belgian edition. Dallas (TX): Antimicrobial Therapy Inc., 1994
Peetermans W, Lacante P. Pneumococcal vaccination by general practitioners: an evaluation of current practice. Vaccine 2000; 18: 612–7
Tengs T, Adams M, Pliskin J, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995; 15 (3): 369–90
Gable C, Botteman M, Savage G, et al. The cost effectiveness of pneumococcal vaccination strategies. Pharmacoeconomics 1997; 12: 161–74
Sisk J, Moskowitz A, Whang W, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1998; 278: 1333–9
Ducoffre G, Walckiers D, Glupczynski Y, et al. Evolution des infections à pneumocoques en Belgique de 1986 à 1991. Acta Clin Belg 1993; 48 (3): 148–55
Verhaegen J, Glupczynski Y, Verbist L, et al. Capsular types and antibiotic susceptibility of pneumococci isolated from patients in Belgium with serious infections, 1980–1993. Clin Infect Dis 1995; 20: 1339–45
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
De Graeve, D., Lombaert, G. & Goossens, H. Cost-Effectiveness Analysis of Pneumococcal Vaccination of Adults and Elderly Persons in Belgium. Pharmacoeconomics 17, 591–601 (2000). https://doi.org/10.2165/00019053-200017060-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200017060-00005