Pneumococcal infection in the elderly: cost-effectiveness of vaccination to reduce demographic losses

Economic evaluation of alternative PCV13 vaccination strategies in Guangxi, China: a decision tree-Markov model study.

BACKGROUND Pneumococcal disease remains a major cause of morbidity and mortality among children under five years of age, particularly in settings with low vaccine coverage. In China, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included in the National Immunization Program (NIP), resulting in suboptimal uptake. This study evaluated the health and economic impact of including PCV13 in the immunization program in Guangxi Zhuang Autonomous Region. METHODS A decision tree-Markov model was used to simulate a birth cohort of 420,000 children over a 5-year horizon from a societal perspective. The current self-paid vaccination strategy was compared with NIP inclusion. Outcomes included costs, cases, deaths, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and benefit-cost ratios (BCRs). Costs and outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses were conducted. RESULTS NIP inclusion increased vaccination coverage from 5900 to 417,019 children and was projected to prevent 77,042 cases and 327 deaths over 5 years. Despite higher vaccination costs, reduced disease burden resulted in a net economic benefit of USD 3.92 million (BCR: 1.03). The program generated an additional 25,702.2 QALYs, with an ICER of USD 6042.75 per QALY gained, below the per capita GDP threshold. Probabilistic sensitivity analysis showed that most simulations were below the willingness-to-pay threshold, with the probability of cost-effectiveness approaching 100%. CONCLUSIONS Including PCV13 in Guangxi's immunization program is highly cost-effective and likely to yield positive economic returns. These findings are robust and support policy decisions on PCV13 inclusion.

Quantifying the societal benefits of adult immunization against respiratory diseases in France: a benefit cost analysis.

BACKGROUND Pneumococcal disease, respiratory syncytial virus (RSV), influenza, and COVID-19 place a significant burden on France's population health, health system, and economy. Older adults and adults in clinical risk groups are recommended to receive vaccination against these illnesses, although RSV is not reimbursed. RESEARCH DESIGN AND METHODS A benefit-cost analysis was conducted to assess the societal return on investment from adult vaccination by estimating benefit-cost ratios (BCRs) and net benefits (NBs). Health outcomes were monetized using established methods. Program costs included all direct vaccination-related expenditures. Scenario and sensitivity analyses assessed alternative program specifications and tested the robustness of the model. RESULTS France's age-based respiratory immunization programs generate a BCR of €2.0 to €8.7 per €1 spent over the lifetime, depending on mortality risk reduction monetization. This corresponds to NBs of €9.7 to €72.6 billion. Introducing adult RSV vaccination with a similar uptake to that in the US could increase NBs by approximately 6%-7% compared to the status quo. Achieving aspirational coverage targets across all programs would increase NBs by 138%-175%. CONCLUSIONS France's adult respiratory vaccination programs generate positive socioeconomic returns. Including adult RSV vaccination and increasing vaccination uptake would further increase their societal benefits. Realizing these gains requires adequate public investment.

Cost-Effectiveness Analysis of the mRNA-1345 RSV Vaccine for Older Adults in Italy

The health and economic burden of invasive pneumococcal diseases attributable to PCV21 versus PCV20 serotypes among adults aged ≥ 45 years in Spain

The 21-valent pneumococcal conjugate vaccine (PCV21) is a new vaccine that includes eight serotypes not found in any currently licensed vaccines. This study estimates the lifetime clinical and economic burden of invasive pneumococcal disease (IPD) in Spain attributable to PCV21 serotypes compared to PCV20 serotypes among Spanish adults aged ≥ 45 years. Using a published state-transition Markov model, the lifetime IPD cases, deaths, and direct medical costs (in 2024 euros) associated with serotypes included in PCV21 and PCV20 were estimated among adults aged 45–64 and ≥ 65 years across three risk groups (low-risk, at-risk, and high-risk). A one-way sensitivity analysis was performed to identify key model inputs influencing the incremental costs of IPD. PCV21 serotypes were associated with approximately 17–20% more lifetime IPD cases and deaths than PCV20 serotypes among adults aged ≥ 45 years. The estimated lifetime direct medical cost for PCV21 serotypes (€291 million) was 14% higher than that of PCV20 (€255 million) among adults aged 45–64 years. Similarly, PCV21 serotypes (€193 million) were 20% higher than PCV20 serotypes (€161 million) among those aged ≥ 65 years. The eight unique serotypes targeted by PCV21 accounted for 29,501 cases and 6,059 deaths (approximately 18–19% of PCV21 serotypes), contributing over €97 million to direct lifetime IPD costs. The highest burden was consistently observed in high-risk groups. The serotypes targeted by PCV21 impose a significantly higher health and economic burden of IPD in Spain relative to PCV20. Consequently, PCV21 may help reduce the health and economic burden of IPD among Spanish adults, supporting its incorporation into national vaccination guidelines and adult immunization strategies.

Live Attenuated Influenza Vaccine (LAIV) for Children for the Prevention of Influenza Illness in Sweden: A Cost-Effectiveness Analysis.

INTRODUCTION Both inactivated influenza vaccine and live attenuated influenza vaccine (LAIV) (indicated for use in children aged 2-17 years) effectively prevent influenza transmission and related outcomes. Despite high transmission among children, vaccination practices in Sweden focus primarily on targeting individuals at higher risk of influenza-related illness and mortality, including older adults. The objective of this study was to assess the cost-effectiveness of increasing LAIV coverage among children aged 2-17 years. METHODS We developed a de novo health economic model (HEM) that included a dynamic transmission model (DTM) component to estimate population-level outcomes for a typical influenza season in Sweden. The DTM implemented a compartmental structure to model the prevalence of three influenza strains over a 1-year time horizon. The HEM used a decision-tree structure to translate epidemiological outputs into clinical and economic outcomes. The model simulated theoretical vaccination scenarios, comparing a reference scenario based on historical vaccination coverage with an intervention with LAIV in which coverage among children aged 2-17 years was increased from 0.36% to 25%. RESULTS Increasing the uptake of LAIV in 2-17-year-olds could prevent a further 505,824 influenza infections in a typical season, two-thirds of which would be prevented in the indirect population (adults and children aged < 2 years). The model estimated this to translate into 33,419 fewer cases requiring medical attention, of which 1929 were hospitalizations, ultimately preventing 193 intensive care unit admissions and 99 deaths. The intervention scenario was considered cost-effective from a payer perspective (direct costs only; incremental cost-effectiveness ratio of SEK 73,266 per quality-adjusted life year) and dominant (cost-saving) from a societal perspective. Sensitivity and scenario analyses showed that results were robust to changes in key model parameters, maintaining cost-effectiveness. CONCLUSIONS In Sweden, the implementation of LAIV is estimated to be cost-effective in 2-17-year-olds by reducing disease burden and healthcare costs in both children and the broader population.

Cost-effectiveness of respiratory syncytial virus vaccination for older adults: a modelling analysis

Background. Evidence of the effectiveness and cost-effectiveness of new vaccines that reduce the burden of respiratory syncytial virus (RSV) in older populations is emerging. The reported cost-effectiveness of these vaccination strategies varies substantially across different settings. This study assessed the cost-effectiveness of older adult-targeted RSV vaccination strategies in the Australian context and compared findings with published evaluations. Methods. We developed an individual-based dynamic transmission model of RSV infection, linked to a clinical pathways and cost-effectiveness model. We modelled different adult vaccination strategies for the general population and the Indigenous population, and present incremental cost-effectiveness ratios (ICERs) as cost per quality-adjusted life year gained, from a healthcare system perspective. Deterministic and probabilistic sensitivity analyses explored drivers of cost-effectiveness and sensitivity of findings to uncertainty in parameter estimates. Results. Vaccinating the general population of older adults in Australia was not found to be cost-effective at a dose price of 100 AUD, but was found to be cost-saving for Indigenous adults, given the higher disease burden in this population. Individual drivers of ICERs in our setting were dose price, hospitalisation incidence and mortality, however conclusions about cost-effectiveness were robust to joint parameter uncertainty. Conclusions. The cost-effectiveness of vaccinating adults against RSV depends on many uncertain and context-specific quantities. Strategies that target high risk populations were found to be cost-effective in Australia due to the larger avertable burden.