Health economic burden attributable to novel serotypes in candidate 24- and 31-valent pneumococcal conjugate vaccines

Background Next-generation pneumococcal vaccines currently in clinical trials include 24- and 31-valent pneumococcal conjugate vaccines (PCV24, PCV31), which aim to prevent upper-respiratory carriage and disease involving the targeted serotypes. We aimed to estimate the comprehensive health-economic burden associated with acute respiratory infections (ARIs) and invasive pneumococcal disease (IPD) attributable to PCV24- and PCV31-additional (non-PCV20) serotypes in the United States. Methods We multiplied all-cause incidence rate estimates for acute otitis media (AOM), sinusitis, and non-bacteremic pneumonia by estimates of the proportions of each of these conditions attributable to pneumococci and the proportions of pneumococcal infections involving PCV24- and PCV31-additional serotypes. We obtained serotype-specific IPD incidence rates from US Active Bacterial Core surveillance data. We accounted for direct medical and non-medical costs associated with each condition to estimate resulting health-economic burden. Non-medical costs included missed work and lost quality-adjusted life years due to death and disability. Results The health-economic burden of PCV24-additional serotypes totaled $1.3 billion ($1.1-1.7b) annually in medical and non-medical costs, comprised of $0.9b ($0.7-1.2b) due to ARIs and $0.4b ($0.3-0.5b) due to IPD. For PCV31-additional serotypes, medical and non-medical costs totaled $7.5b ($6.6-8.6b) annually, with $5.5b ($4.7-6.6b) due to ARIs and $1.9b ($1.8-2.1b) due to IPD. The largest single driver of costs was non-bacteremic pneumonia, particularly in adults aged 50-64 and ≥65 years. Conclusions Additional serotypes in PCV24 and PCV31, especially those included in PCV31, account for substantial health-economic burden in the United States. Summary Novel serotypes in 24- and 31-valent pneumococcal conjugate vaccines, currently in clinical trials, account for substantial health-economic burdens in the United States, especially in adults ≥50 years. Vaccines targeting these serotypes may prevent pneumococcal disease and reduce associated costs.