Cost-Effectiveness of Conjugate Pneumococcal Vaccines in At-Risk Adults Aged 18 to 64 Years

Eight economic evaluations (6 peer-reviewed, 2 summarized in a single grey literature source) assessing the cost-effectiveness of pneumococcal conjugate vaccines in adults aged 18 to 64 years at high risk of invasive pneumococcal disease (IPD) in high-income countries were identified. The 2 economic evaluations summarized in the single grey literature source were industry-sponsored analyses. A version of the results was previously summarized by the Public Health Agency of Canada. As such, the methods and results of the industry-funded models are only summarized in Appendix 3 for this review. None of the peer-reviewed studies identified assessed the cost-effectiveness of pneumococcal 15-valent conjugate vaccine (PCV15), pneumococcal 20-valent conjugate vaccine (PCV20), or pneumococcal 21-valent conjugate vaccine (PCV21). Of the peer-reviewed studies, 2 were conducted in the US, 2 in South Korea, 1 in Spain, and 1 in Hong Kong. All results were presented in terms of incremental cost-effectiveness ratios (ICERs) (i.e., incremental cost per quality-adjusted life-years gained). Four studies concluded that 1 dose of pneumococcal 13-valent conjugate vaccine (PCV13) was cost-effective relative to either no vaccination, 2 doses of PCV13, PCV13 plus 2 doses of pneumococcal polysaccharide 23-valent vaccine (PPSV23), or 2 doses of PPSV23. Two studies concluded that PCV13 plus PPSV23 was cost-effective relative to either no vaccination or 1 dose of PPSV23, but the studies did not evaluate the cost-effectiveness of PCV13 alone. The studies did not all consider the same vaccination strategies. The sources used to parameterize vaccine effectiveness in the peer-reviewed studies are highly uncertain, as the clinical evidence was either not representative of the target population or heavily reliant on expert input and assumptions. The generalizability of the economic evaluations may be limited because the study settings were notably different from Canada. To estimate the potential cost-effectiveness of pneumococcal conjugate vaccines in Canada, a de novo economic evaluation conducted from a setting is Canada is required.