Original Title: Coste-efectividad de la vacunación antineumocócica en adultos > 60 ańos

Authors' objectives: The aim of this report is to evaluate the efficiency of the use of the pneumococcal conjugate vaccine in addition to the pneumococcal polysaccharide vaccine in the immunocompetent elderly population. We assess the cost-effectiveness of adding the PPC13 vaccine alongside the PPV23 for immunocompetent adults over the age of 60 in comparison with using only the PPV23 vaccine for this age group.

Authors' results and conclusions: RESULTS: After removing duplicates, 1,816 articles were identified. After reading titles and abstract 95 papers were selected and the final selection included 19 articles: 7 systematic reviews of effectiveness, 3 systematic reviews of economic evaluations, and 9 economic evaluations. There is evidence indicating that both vaccines have a positive clinical impact on the elderly. Furthermore, both vaccines have excellent safety profiles. However, there are not direct comparison on the clinical effectiveness between PPV23 and PPC13. A series of economic evaluation have shown that both vaccines are cost-effective when compared with the option of no vaccination. However, the conclusion regarding which vaccine is more cost-effective, i.e. PPV23 or PPC13, varied according to key parameters and assumptions applied in the studies. We did not identify cost-effectiveness analysis undertaken in Spain. The two more recent studies not funded by the industries did not consider cost-effective the option of adding PPC13 to the current PPV23 vaccination for the immunocompetent elderly population. The de novo cost-effectiveness analysis undertaken in this report concluded that adding the PPC13 vaccine as a complement to PPV23 for adults above the age of 60 without immunosuppression is not a cost-effective strategy compared with using PPV23 alone. However, the sequential strategy (PPC13 + PPV23) was found to be strongly cost-effective among individuals with immunosuppression. CONCLUSIONS: The use of PPC13 as a complement to PPV23 in the immunocompetent elderly population is not cost-effective compared with using the PPV23 vaccine alone in this group.

Authors' recommendations: We recommend maintaining the current vaccine strategy agreed by the Interterritorial Council of the National Health System, consisting on the systematic use of PPV23 for the elderly without immunosuppression, and the use of both vaccines (PPC13 + PPV23) for individuals of any age with immunosuppression and with the following conditions: cerebrospinal fluid leakage, persons with cochlear implant, previous IPD and hepatic cirrhosis.

Authors' methods: We conducted a systematic literature review of the safety, effectiveness and cost-effectiveness of both vaccine strategies. In addition, we developed a de novo cost-effectiveness analysis using the most up-to-date evidence and focussed to the Spanish context. For the systematic review, a search strategy was developed to identify studies on the safety, effectiveness as well as economic evaluations. The inclusion criteria were: studies on immunocompetent individuals over the age of 60 from industrialised countries that assess the PPC13 vaccine against no vaccine, or against PPV23 as an alternative, or against PPV23 as a complement. Cochrane Systematic Reviews Database, MEDLINE, PREMEDLINE, CINAHL, HBE y EMBASE were searched until March 2017. Two researchers selected the articles independently, and the studies were assessed according to their methodological quality. Data extraction was undertaken by one researcher and double checked by a second researcher. Characteristics and results of included papers were synthesized and presented in tables. The cost-effectiveness model compared, in the base case, the strategy of adding PPC13 for the immunocompetent elderly population against the current recommendation of using the PPV23 vaccines only for this age group. In additional analysis, we included as comparators the strategy of no vaccination, and the use of PPC13 only. We used a Markov model with annual cycles on an initial cohort of the population aged 60 years. We conducted a deterministic analysis using the expected value of each parameter, and a probabilistic sensitivity analysis to quantify the uncertainty around the decision. A comprehensive sensitivity analysis by scenarios was performed to asses the robustness of the conclusions to changes in the values of key parameters.

Project Status: Completed

Year Published: 2017

URL for published report: https://sescs.es/coste-efectividad-de-la-vacunacion-antineumococica-en-adultos-60-anos/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es