Public health and budgetary impact of 20-valent pneumococcal conjugate vaccine for adults in England

Despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) in England, disease burden among at-risk adults remains high. We evaluated the public health and budgetary impact of 20-valent pneumococcal conjugate vaccine (PCV20) compared to the current adult pneumococcal vaccination program. Five-year outcomes and 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. Hypothetical vaccination with PCV20 versus PPV23 was compared from the National Health Service (NHS) perspective. Replacing PPV23 with PCV20 would prevent 785 IPD hospitalizations, 11,751 CAP hospitalizations, and 1,414 deaths over 5 years, and would reduce medical care costs by £48.5 M. With vaccination costs higher by £107.2 M, projected net budgetary impact is £58.7 M. The budgetary impact would be greatest in year 1 (£26.3 M), and would decrease over time (to £1.6 M by year 5). The average budget increase (£11.7 M/year) represents <0.01% of the Department of Health and Social Care total budget and <3% of the vaccine budget. Use of PCV20 among adults currently eligible for PPV23 in England would substantially reduce the burden of pneumococcal disease, with modest budgetary impact.

尽管英国已在临床中应用23价肺炎球菌多糖疫苗（PPV23），但高危成人群体的肺炎球菌疾病负担仍居高不下。本研究对比了20价肺炎球菌结合疫苗（PCV20）与当前成人肺炎球菌免疫规划方案的公共卫生效益及预算影响，采用确定性队列模型，对英国境内65~99岁成人，以及伴有基础疾病的18~64岁成人的侵袭性肺炎球菌疾病（IPD）与社区获得性肺炎（CAP）的5年转归及相关医疗成本进行了预测。研究从英国国家医疗服务体系（NHS）的视角出发，模拟了以PCV20替代PPV23的假想接种场景。结果显示，在5年研究周期内，以PCV20替换PPV23可避免785例IPD住院病例、11751例CAP住院病例，以及1414例死亡病例，同时可缩减医疗开支4850万英镑。尽管PCV20的接种成本较PPV23高出1.072亿英镑，预计净预算影响为5870万英镑。该预算影响在第1年达到峰值（2630万英镑），随后逐年递减，至第5年降至160万英镑。年均预算增幅为1170万英镑，仅占英国卫生与社会保健部总预算的0.01%以下，且不足其疫苗专项预算的3%。综上，在英国当前符合PPV23接种指征的成人群体中推广PCV20接种，可大幅降低肺炎球菌相关疾病负担，且仅带来适度的预算影响。