Cost effectiveness and public health impact of PCV20 among adults in France.

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

Vaccination of Russian people aged ≥60 years with PCV20 provides the greatest reduction in pneumococcal infection incidence and is highly cost-effective compared to PPV23 vaccination and is cost-effective compared to sequential PCV13/PPV23 vaccination.

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.

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

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.

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.

Severe invasive pneumococcal disease beyond current vaccination recommendations: implications for higher-valency vaccines.

OBJECTIVES To describe the epidemiology, clinical characteristics, and serotype distribution of invasive pneumococcal disease (IPD) in adults in Southern Switzerland, and to evaluate the theoretical coverage of higher-valency pneumococcal conjugate vaccines, with particular focus on patients without current vaccination indications. METHODS This retrospective study included all adults with microbiologically confirmed IPD admitted to four hospitals in Southern Switzerland between January 2019 and December 2024. Clinical data, serotypes, and vaccination status were collected. Theoretical vaccine coverage was calculated for PCV13, PCV15, PCV20, and PCV21. Multivariable logistic regression identified predictors of intensive care unit (ICU) admission and mortality. RESULTS Among 210 patients (mean age 69.3 years), 79 (37.6%) were admitted to the ICU and 18 (8.6%) died. Charlson Comorbidity Index was the only independent predictor of both ICU admission (OR 1.25, 95% CI 1.02-1.57) and mortality (OR 2.37, 95% CI 1.54-3.64). Serotype 8 was the most frequent isolate (21.0%), followed by serotypes 3 (13.3%) and 4 (9.5%). Only 9.9% of patients had received prior pneumococcal vaccination. Fifty-six patients (26.7%) were aged < 65 years without comorbidities and had no vaccination indication; 44.6% of these were admitted to the ICU. Serotype 8 accounted for 30.4% of infections in this subgroup. PCV13 and PCV15 would have covered 28.6% and 33.9% of cases in non-eligible adults, whereas PCV20 and PCV21 would have covered 67.9% and 73.2%, respectively. CONCLUSIONS More than one-quarter of adult IPD occurred in individuals without current vaccination indications, with high rates of severe disease. Higher-valency conjugate vaccines could substantially expand serotype coverage in this population, supporting reconsideration of age-based vaccination strategies.