Cost-effectiveness of adult vaccinations: A systematic review

Abstract

Background: Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize economic evidence for adult vaccinations included on the adult immunization schedule.

Methods: We searched PubMed, EMBASE, EconLit, and Cochrane Library from 1980 to 2016 and identified economic evaluation or cost-effectiveness analysis for vaccinations targeting persons aged ≥18 years in the U.S. or Canada. After excluding records based on title and abstract reviews, the remaining publications had a full-text review from two independent reviewers, who extracted economic values that compared vaccination to "no vaccination" scenarios.

Results: The systematic searches yielded 1688 publications. After removing duplicates, off-topic publications, and publications without a "no vaccination" comparison, 78 publications were included in the final analysis (influenza = 25, pneumococcal = 18, human papillomavirus = 9, herpes zoster = 7, tetanus-diphtheria-pertussis = 9, hepatitis B = 9, and multiple vaccines = 1). Among outcomes assessing age-based vaccinations, the percent indicating cost-savings was 56% for influenza, 31% for pneumococcal, and 23% for tetanus-diphtheria-pertussis vaccinations. Among age-based vaccination outcomes reporting $/QALY, the percent of outcomes indicating a cost per QALY of ≤$100,000 was 100% for influenza, 100% for pneumococcal, 69% for human papillomavirus, 71% for herpes zoster, and 50% for tetanus-diphtheria-pertussis vaccinations.

Conclusions: The majority of published studies report favorable cost-effectiveness profiles for adult vaccinations, which supports efforts to improve the implementation of adult vaccination recommendations.

Keywords: Adults; Cost-effectiveness; Vaccines.

Fig. 1.

Cascade diagram of search results and exclusion criteria from a systematic review of adult vaccination cost-effectiveness and economic evaluation publications. Note (s): Td/Tdap = tetanus-diphtheria-pertussis; Pneumo = pneumococcal; Hep B = hepatitis B; HPV = human papillomavirus; HZ = herpes zoster.

Fig. 2.

Summary of cost-effectiveness results on (a) age-based vaccinations and (b) indication-based vaccinations, stratified by vaccine group, from a systematic review of adult vaccination cost-effectiveness and economic evaluation publications. Note(s): Each data point or range represents one outcome that assessed cost-effectiveness in terms of cost per QALY saved. The data points are partially transparent such that darker points represent two or more observations. Each column represents a single study, e.g., multiple data points in a single column are different cost-effectiveness ratios or ranges taken from the same study. The data points with error bars or lines indicate outcomes where a range of cost-effectiveness was abstracted and in these cases the midpoints of the ranges are illustrated with the data point. In the age-based vaccinations, there were no hepatitis B studies, and in the indication-based studies there were no herpes zoster studies. To simplify presentation, cost-effectiveness ratios that were cost-saving (where costs were less and outcomes were greater than the “no vaccination” comparator) are located on the x-axis where $/QALY equals zero. Also to simply presentation, cost-effectiveness ratios that were greater than $500,000 per QALY saved are indicated with an “X” on the figure.