Cost-effectiveness of using a 20-valent pneumococcal conjugate vaccine to directly protect adults in England at elevated risk of pneumococcal disease

Despite the current pneumococcal vaccination program in England for older adults and adults with underlying conditions, disease burden remains high. We evaluated cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to current pneumococcal recommendations for adults in England. Lifetime outcomes/costs of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) among adults aged 65–99 years and adults aged 18–64 years with underlying conditions in England were projected using a deterministic cohort model. Vaccination with PCV20 was compared with 23-valent pneumococcal polysaccharide vaccine (PPV23) from the National Health Service perspective. PCV20 was cost saving compared with PPV23 in base case and most sensitivity analyses. In the base case, replacing PPV23 with PCV20 prevented 7,789 and 140,046 cases of IPD and hospitalized CAP, respectively, and 22,199 associated deaths, resulting in incremental gain of 91,375 quality-adjusted life-years (QALYs) and incremental savings of £160M. In probabilistic sensitivity analyses, PCV20 (vs. PPV23) was cost saving in 85% of simulations; incremental cost per QALY was below £30,000 in 99% of simulations. PCV20 vaccination in adults aged 65–99 years and those aged 18–64 years with underlying comorbidities in England is expected to prevent more hospitalizations, save more lives, and yield lower overall costs than current recommendations for PPV23.

尽管英格兰已针对老年人群及存在基础疾病的成人推行肺炎球菌疫苗接种计划，但当地的疾病负担仍处于较高水平。本研究针对英格兰成人人群，评估了20价肺炎球菌结合疫苗（20-valent pneumococcal conjugate vaccine, PCV20）相较于现行肺炎球菌疫苗接种建议的成本效益。本研究采用确定性队列模型，对英格兰65~99岁成人以及18~64岁存在基础疾病的成人群体中，侵袭性肺炎球菌疾病（invasive pneumococcal disease, IPD）与社区获得性肺炎（community-acquired pneumonia, CAP）的终生结局与相关成本进行了预测。从英国国家医疗服务体系（National Health Service, NHS）的决策视角出发，将PCV20接种方案与23价肺炎球菌多糖疫苗（23-valent pneumococcal polysaccharide vaccine, PPV23）进行了对比分析。基准情景与绝大多数敏感性分析结果均显示，PCV20接种方案相较于PPV23可实现成本节约。在基准情景下，用PCV20替代PPV23可分别避免7789例侵袭性肺炎球菌疾病、140046例需住院治疗的社区获得性肺炎病例，以及22199例相关死亡病例，可带来91375个质量调整生命年（quality-adjusted life-years, QALYs）的增量获益，并节省1.6亿英镑的医疗成本。在概率敏感性分析中，85%的模拟结果显示PCV20相较于PPV23可实现成本节约；99%的模拟结果显示，每获得1个质量调整生命年的增量成本低于30000英镑。综上，相较于英格兰现行的PPV23接种建议，为当地65~99岁成人以及18~64岁存在基础共病的成人接种PCV20，有望减少更多住院病例、挽救更多生命，并降低总体医疗成本。