Authors' recommendations: In adults 50-84 years of age, both PPV23 and PCV13 vaccines decrease the number of outpatient episodes, hospital admissions and deaths due to pneumococcal disease caused by the serotypes they cover. Since PPV23 covers more serotypes, but exerts more uncertain protection against non-invasive pneumococcal pneumonia, neither vaccine is superior to the other. To the federal (INAMI/RIZIV) and federated authorities competent in the field of vaccination: • Under most assumptions and hypotheses tested in this study, PPV23 is more costeffective than PCV13. This is also valid when we assume no PPV23 protection against noninvasive pneumonia. • An increase of PPV23 uptake in the 75-84 year-olds would be the most cost-effective intervention, whether or not we assume that PPV23 protects against non-invasive pneumonia. At the current PPV23 price, the incremental cost per QALY gained (ICER) would be €52 000 with or €85 000 without assuming PPV23 protection against non-invasive pneumonia. At a PPV23 price reduced by 75%, the cost per QALY would drop to €20 000 with or €37 000 without assuming PPV23 protection against non-invasive pneumonia. • A combination of PPV23 and PCV13 vaccines is less cost-effective than the administration of a single vaccine. In particular, compared to PPV23 alone, the addition of PCV13 would only prevent a modest number of additional hospitalisations and deaths, at a cost per QALY exceeding €200 000. • PCV13 would only be more cost-effective than PPV23 under the assumptions of: o a drastic price reduction (≥75%), and o a markedly longer duration of PCV13 protection than currently established , and o an increase in the proportion of pneumococcal cases caused by PCV13 serotypes. • The incidence and serotypes of pneumococcal disease in the elderly should be determined and monitored, to detect any change in the epidemiology that would put into question the conclusions from the present study. To the clinicians: The current spectrum of pneumococcal serotypes covered in adults ismuch smaller for PCV13 than for PPV23, and continues to decline under the influence of infant PCV vaccination. The 11 serotypes that are covered by PPV23 but not by PCV13 represent today 42% of invasive disease and 24% of non-invasive pneumonia. If PCV13 is administered, it should be followed by PPV23 (after at least 8 weeks) to protect against these additional serotypes.

Project Status: Completed

Year Published: 2016

URL for published report: https://doi.org/10.57598/R274C

URL for additional information: https://kce.fgov.be/en/use-of-pneumococcal-vaccines-in-the-elderly-an-economic-evaluation

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Belgium

DOI: 10.57598/R274C

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

Copyright: Belgian Health Care Knowledge Centre (KCE)