Economic Burden of Pneumococcal Disease Among US Children — A Review of Cost-Effectiveness Analyses of Pneumococcal Vaccines

OBJECTIVES: This study aimed to summarize the economic burden of pneumococcal disease (PD) in children from cost-effectiveness analyses (CEAs) of pneumococcal vaccines in the US.

METHODS: A targeted literature review identified US CEAs of pediatric pneumococcal vaccines from 2000-2023. Inputs on costs of PD and post-meningitis sequelae (PMS) were extracted and converted to 2023 USD. The original publications where these inputs were estimated were also reviewed.

RESULTS: Eleven CEAs were identified: 9 applied both direct medical costs and direct nonmedical/indirect costs, while 2 only included direct medical costs. Direct medical costs per PD episode ranged from $12,036-$67,855 (meningitis), $4,452-$60,963 (non-meningitis invasive PD [IPD]), $11,990-$25,663 (unspecified/combined IPD), $7,223-$44,928 (inpatient pneumonia), $336-$545 (outpatient pneumonia), $316-$8,351 (unspecified/combined pneumonia), $130-$311 (simple acute otitis media [AOM]), $737-$1,269 (complex AOM), $80-$414 (unspecified/combined AOM), and $2,738-$4,886 (tympanostomy tube placement). The nonmedical/indirect costs were $1,015-$4,343 (meningitis), $583-$1,020 (non-meningitis IPD), $503-$1,020 (inpatient pneumonia), $436-$521 (outpatient pneumonia), $512-$689 (unspecified/combined pneumonia), $200-$371 (simple AOM), $200-$1,521 (complex AOM), $190-$394 (unspecified/combined AOM), and $236-$1,208 (tympanostomy tube placement). Lifetime direct medical costs and nonmedical/indirect costs for PMS were reported, with $247,619-$851,340 and $166,851-$2,044,776 for disability, and $46,393-$164,994 and $149,412-$545,031 for deafness. Most inputs for PD costs were sourced from unpublished database analyses; only 3 published studies were referenced. The study published in 2023 reported much higher costs compared to previous studies. Cost inputs for PMS were derived from 3 studies published in 1996-2004.

CONCLUSIONS: PD imposes substantial economic burdens on the healthcare system and society. However, the published US CEAs reveal considerable variation in PD costs, substantially impacting estimates of the cost-effectiveness of pneumococcal vaccines. The reliance on unpublished or outdated data sources for most inputs underscores the need for a comprehensive review, which is crucial to enhance the understanding of PD economic burden and to provide robust inputs for future economic evaluations of pneumococcal vaccines.