Cost-effectiveness analysis of pneumococcal vaccination of at-risk and high-risk adults aged 18-64 years in Switzerland using PCV21.
TL;DR
Implementing PCV21 for at-risk and high-risk adults 18-64 years in Switzerland was predicted to avert 518 invasive pneumococcal disease cases, 12 post-meningitis sequelae cases, and 2,578 inpatient non-bacteremic pneumococcal pneumonia cases and 224 deaths.
Abstract
Background
Pneumococcal disease (PD) is more common and severe among adults with underlying medical conditions. Pneumococcal vaccination is recommended but not reimbursed in Switzerland for adults 18-64 years with these risk factors.
Objective
We estimated the cost-effectiveness of reimbursed vaccination for high-risk (immunocompromised) and at-risk (chronic medical condition) adults 18-64 years in Switzerland using 21-valent pneumococcal conjugate vaccine (PCV21).
Methods
We updated a published state-transition Markov model to estimate lifetime health and economic outcomes for multiple adult cohorts, following individuals until death or age 100 years, from the Swiss payer perspective. Swiss demographic and health economic data were used where available and supplemented with proxy epidemiologic estimates from comparable international sources when Swiss-specific data were unavailable. Vaccination of 60% of the target population with PCV21 was compared with no pneumococcal vaccination. One-way and probabilistic sensitivity analyses assessed parameter uncertainty and model robustness.
Results
Implementing PCV21 for at-risk and high-risk adults 18-64 years in Switzerland was predicted to avert 518 invasive pneumococcal disease cases, 12 post-meningitis sequelae cases, and 2,578 inpatient non-bacteremic pneumococcal pneumonia (NBPP) cases and 224 deaths. The CHF 21.4 M decrease in direct PD treatment costs partially offset the CHF 39.0 M vaccination costs, resulting in an incremental cost-effectiveness ratio (ICER) of 7,665 CHF/quality-adjusted life year (QALY) gained. The ICER was 1,750 CHF/QALY in a scenario analysis in which the proportions of adults with risk conditions increased with age. One-way sensitivity analysis found results were most sensitive to vaccine efficacy against NBPP in the at-risk group and discount rate. In probabilistic sensitivity analyses, the probability that PCV21 was cost-effective reached 100% at willingness-to-pay thresholds of approximately CHF 18,000 or higher.
Conclusions
Vaccination of at-risk and high-risk adults 18-64 years of age in Switzerland using PCV21 is likely to be cost-effective.