Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands
European Respiratory Journal Nov 2015, 46 (5) 1407-1416
Marie-Josée J. Mangen, Mark H. Rozenbaum, Susanne M. Huijts, Cornelis H. van Werkhoven, Douwe F. Postma, Mark Atwood, Anna M.M. van Deursen, Arie van der Ende, Diederick E. Grobbee, Elisabeth A.M. Sanders, Reiko Sato, Theo J.M. Verheij, Conrad E. Vissink, Marc J.M. Bonten, G. Ardine de Wit
The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands.
Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65–74years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted.
The ICER for base-case was €8650 per QALY (95% CI 5750–17100). Vaccination of high-risk individuals aged 65–74years was cost-saving and extension to medium-risk individuals aged 65–74years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18years yielded an ICER of €3100.
PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries.