Replacing PPSV23 With PCV13 May Prevent More Pneumonia

PCV13 vaccine might prevent more pneumococcal disease; still economically reasonable

TUESDAY, Feb. 21 (HealthDay News) -- A model shows that replacing the current 23-valent pneumococcal polysaccharide vaccine (PPSV23) with the 13-valent pneumococcal conjugate vaccine (PCV13) might prevent more pneumococcal disease, while remaining economically reasonable, according to a study published in the Feb. 22 issue of the Journal of the American Medical Association.

Using hypothetical cohorts of U.S. 50-year-olds, Kenneth J. Smith, M.D., of the University of Pittsburgh, and colleagues estimated the cost-effectiveness of PCV13 vaccination strategies in adults. Vaccination strategies and effectiveness estimates were developed, and indirect effects (herd immunity) resulting from childhood PCV13 vaccination were extrapolated based on observed 7-valent pneumococcal conjugate vaccine effects.

The researchers found that the base case scenario (administration of PCV13 as a substitute for the currently recommended PPSV23 at age 65 years and at younger ages if comorbidities are present) cost $28,900 per quality-adjusted life-year (QALY) gained, compared with no vaccination. The base case scenario was more cost-effective than the currently recommended PPSV23 strategy. Compared with PCV13 substituted in current recommendations, routine PCV13 at ages 50 and 65 years cost $45,100 per QALY. Adding PPSV23 at age 75 years to PCV13 at ages 50 and 65 years resulted in a gain of 0.00002 QALYs and cost $496,000 per QALY gained. Results were robust except when there was the assumption of low PCV13 effectiveness against nonbacteremic pneumococcal pneumonia or when greater indirect effects of childhood vaccination were modeled. In these cases, current recommendations of PPSV23 were favored.

"PCV13 might prevent more pneumococcal disease compared with current PPSV23 vaccination recommendations," the authors write.

Two of the authors disclosed financial relationships with Merck.

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