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. 2018 Feb 9;13(2):e0192640.
doi: 10.1371/journal.pone.0192640. eCollection 2018.

Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands

Dominic Thorrington  1 , Leo van Rossum  2 , Mirjam Knol  3 , Hester de Melker  3 , Hans Rümke  4 , Eelko Hak  5 , Albert Jan van Hoek  3   6
Affiliations

Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands

Dominic Thorrington et al. PLoS One. .

Abstract

Background: Streptococcus pneumoniae causes morbidity and mortality among all ages in The Netherlands. To reduce this burden, infants in The Netherlands receive the 10-valent pneumococcal conjugated vaccine (PCV10), but older persons are not targeted. We assessed the impact and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) or 13-valent PCV (PCV13) among all those aged 60, 65 or 70 and/or in combination with replacing PCV10 with PCV13 in the infant vaccination programme.

Methods: A static cost-effectiveness model was parameterized including projected trends for invasive pneumococcal disease (IPD) and hospitalised community acquired pneumonia (CAP). The different strategies were evaluated using vaccine list prices and a 10-year time horizon. Incremental cost-effectiveness ratios (ICER) were calculated with the current strategy (infant vaccination program with PCV10) as reference.

Results: Compared to the reference, the largest impact on pneumococcal disease burden was projected with a combined use of PCV13 among infants and PPV23 at 60, 65 and 70 years, preventing 1,635 cases of IPD and 914 cases of CAP. The most cost-effective strategy was vaccinating with PPV23 at 70 years only with similar low ICERs at age 60 and 65. The impact of the use of PCV13 among infants depends strongly on the projected herd-immunity effect on serotype 19A. Vaccinating elderly with either PCV13 or PPV23 was dominated by PPV23 in all investigated scenarios, mainly due to the lower price of PPV23.

Conclusion: Under the current assumptions, the best value for money is the use of PPV23 for elderly, with a single dose or at five year increment between age 60 to age 70.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
The assumed vaccine effectiveness against IPD (panel A; independent of age) and the vaccine effectiveness against vaccine type hospitalised CAP (panel B; independent of age).
Fig 2
Fig 2. Projected cases of invasive pneumococcal disease under the different strategies.
Panel A) current strategy of vaccinating infants with PCV10 including a herd effect for the PCV10 minus PCV7 serotypes and increase of the non-PCV13 serotypes. Panel B) with a strategy when PCV13 is introduced among infants, with a 40% herd protection effect against 19A, also including the indirect effects against PCV10 minus PCV7 serotypes and an increase in non-PCV13 serotypes. Panel C) for a strategy where PCV13 is introduced among infants with a 90% herd protection against 19A, also including the indirect effects against PCV10 minus PCV7 serotypes and an increase in non-PCV13 serotypes.
Fig 3
Fig 3. Cost-effectiveness plane for the presented scenarios (using a 10 year time horizon).
The dotted line represents a cost-effectiveness threshold of €20,000 per QALY.
See this image and copyright information in PMC

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