Aims This study aimed to evaluate the cost-effectiveness of newly developed higher-valent pneumococcal conjugate vaccines (PCVs)-including PCV15, PCV20, and PCV21-for adult populations through a systematic review and meta-analysis of economic evaluations (MAEE), providing pooled incremental net benefits (INBs) as a quantitative summary across studies.Methods Economic evaluation studies of PCV15, PCV20, or PCV21 were identified through database searches (PubMed, EMBASE, EconLit, Tufts CEA registry, HTA database, and NITAG resource center) through November 2024. INBs were calculated and pooled using a random-effects model, with positive INB indicating cost-effectiveness. Outcomes were stratified by population age (≥18, ≥50, and ≥60 years), perspective (healthcare and societal), and country income level. Sensitivity analyses assessed the impact of funding sources, imputed variance, and incomplete sensitivity analysis.Results Twenty-seven studies were included, with 14 comparisons eligible for meta-analysis. PCV20 was the most frequently studied vaccine. From a healthcare perspective, PCV20 was significantly cost-effective compared to PCV15 followed by PPSV23 (PCV15 + PPSV23) in ≥18 population (INB: 19.3; 95% CI: 14.2 to 24.4) and ≥60 population (44.3; 21.1 to 67.4). A similar trend was observed when compared against PPSV23 alone (269.3; 96.4 to 442.1 and 161.2; 3.5 to 318.9). Among ≥18 population, PCV20 showed favorable INBs compared to PCV13 + PPSV23 (241.7; -5.6 to 488.9; healthcare perspective) and (171.4; -44.2 to 386.9; societal perspective), and no vaccine (65.6; -35.7 to 167.0; healthcare perspective). Among ≥60 population, PCV20 was significantly cost-effective compared to PCV15 alone (37.5; 28.0 to 47.0), but not compared to no vaccine (-13.3; -122.0 to 95.5). PCV15 and PCV21 had few meta-analyzable comparisons.Conclusions Higher-valent PCVs appear cost-effective in most adult populations and settings, especially in high-income countries and from the healthcare perspective. This meta-analysis provides a rigorous quantitative synthesis to support vaccine policy decisions.
Lee et al. (Thu,) studied this question.