Health impact and cost-effectiveness analysis of introducing a national immunization program with 21-valent versus 20-valent pneumococcal conjugate vaccines for adults ≥ 65 years of age in Denmark

BACKGROUND: is a vaccine-preventable bacterium responsible for invasive pneumococcal disease (IPD). Adults ≥ 65 are most susceptible to IPD, and pneumococcal vaccines may reduce morbidity and mortality. RESEARCH DESIGN AND METHODS: A deterministic dynamic transmission model evaluated the health impact and cost-effectiveness of a 21-valent pneumococcal conjugate vaccine (PCV; PCV21) national immunization program (NIP) compared with a 20-valent PCV (PCV20) NIP for adults ≥ 65 in Denmark from 2020 through 2120. Cumulative pneumococcal disease cases and deaths averted, quality-adjusted life years (QALYs), and societal healthcare costs are reported. An incremental cost-effectiveness ratio (ICER) was calculated comparing a PCV21 NIP to a PCV20 NIP. RESULTS: Compared to a PCV20 NIP, a PCV21 NIP would avert an additional 29,309 non-bacteremic pneumococcal pneumonia (NBPP) cases, 9,625 hospitalizations (IPD and inpatient NBPP), 627 IPD cases, and 1,312 deaths over 100 years for the ≥65 age group. Further, 835.2 million Danish kroner of societal cost savings and 759 QALYs would be gained with a PCV21 NIP. The ICER value indicates PCV21 NIP would be a cost-saving dominant strategy for adults ≥ 65. CONCLUSIONS: Implementing a PCV21 NIP for adults ≥ 65 would be a cost-effective strategy to help reduce the burden of pneumococcal disease-related morbidity and mortality in Denmark.