Pneumococcal vaccination strategies in 50-year-olds to decrease racial disparities: a US societal perspective cost-effectiveness analysis

Objectives This study assesses the impact of expanding pneumococcal vaccination to all 50-year-olds to decrease racial disparities by estimating from the societal perspective, the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) and 15-valent conjugate vaccine followed by 23-valent polysaccharide vaccine (PCV15/PPSV23) for 50-year-olds. Methods A Markov model compared the cost-effectiveness of PCV20 or PCV15/PPSV23 in all general population 50- and 65-years-olds compared to current US recommendations and to no vaccination in US Black and non-Black cohorts. US data informed model parameters. Pneumococcal disease societal costs were estimated using direct and indirect costs of acute illness and of pneumococcal-related long-term disability and mortality. Hypothetical 50-year-old cohorts were followed over their lifetimes with costs and effectiveness discounted 3%/year. Deterministic and probabilistic sensitivity analyses assessed model uncertainty. Results In Black cohorts, PCV20 for all at ages 50/65 was the least costly strategy and had greater effectiveness than no vaccination and current recommendation strategies, while PCV15/PPSV23 at 50/65 cost more than $1 million per quality adjusted life year (QALY) gained compared to PCV20 at 50/65. In non-Black cohorts, PCV20 at 50/65 cost $62,083/QALY and PCV15/PPSV23 at 50/65 cost more than $1 million/QALY with current recommendations again more costly and less effective. In probabilistic sensitivity analyses, PCV20 at 50/65 was favored in 85.7% (Black) and 61.8% (non-Black) of model iterations at a $100,000/QALY gained willingness-to-pay threshold. Conclusions When considering the societal costs of pneumococcal disease, PCV20 at ages 50/65 years in the general US population is a potentially economically viable strategy, particularly in Black cohorts.