Authors' objectives: To assess the effectiveness, safety and cost-effectiveness of pneumococcal vaccination with PPV23 for elderly.

Authors' results and conclusions: There was good level of retrievable evidence to suggest that pneumococcal vaccination with PPV23 in elderly population had low to moderate efficacy against invasive pneumococcal disease (IPD) and pneumococcal pneumonia. Evidence on effectiveness of PPV23 against all-cause pneumonia and mortality were not statistically significant. There was no serious adverse events and safety issues reported in the included studies. Cost analyses done in various countries showed inconsistent results. The estimates of disease burden, vaccine effectiveness, cost assumptions and the effects of herd protection had the most influence on the results. Introduction of pneumococcal vaccination with PPV23 for elderly in Malaysia is estimated to have major financial implication. Various international organisations from industrialised countries recommend pneumococcal vaccination with PPV23 for the elderly and other high-risk groups. However, WHO stated that in resource limited settings where there are many competing health priorities, a higher priority should be given to introducing and maintaining high coverage of infants with PCV vaccine given the substantial effects of herd immunity in adult age groups following routine infant immunisation.

Authors' recommendations: Based on the above review, pneumococcal vaccination using PPV23 targeting higher risk groups such as Hajj pilgrims may be considered by policy makers. However, the current evidence does not support routine pneumococcal vaccination with PPV23 for elderly to be included in the National Immunisation Programme due to its high cost implication and subtle effectiveness. Pneumococcal vaccination targeting immunocompromised elderly requires further research.

Authors' methods: Studies were identified by searching electronic databases. The following databases were searched through the Ovid interface: MEDLINE(R) In-process and other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to present. EBM Reviews-Cochrane Database of Systematic Reviews (2005 to December 2020), EBM Reviews-Cochrane Central Register of Controlled Trials (December 2020), EBM Reviews – Database of Abstracts of Review of Effects (1st Quarter 2020), EBM Reviews-Health Technology Assessment (1st Quarter 2020), EBM Reviews-NHS Economic Evaluation Database (1st Quarter 2020). Parallel searches were run in PubMed. No limits were applied to the search. The last search was run on 8 December 2020. Additional articles were identified from reviewing the references of retrieved articles. One of the tools used to assess the risk of bias and methodological quality of all the articles retrieved is the Critical Appraisal Skills Programme (CASP) checklist. All full text articles were then graded based on guidelines from the U.S./Canadian Preventive Services Task Force.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/370

Requestor: Ministry of Health, decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)