Systematic Literature Review of Cost-Effectiveness Analyses of Adult 15- and 20-Valent Pneumococcal Vaccines

OBJECTIVES: The economic and public health benefits of adult pneumococcal vaccines can vary across countries due to different epidemiology and costs. We systematically reviewed and summarized the findings and assumptions of cost-effectiveness analyses (CEA) of the recently introduced 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20) in adult populations globally.

METHODS: We performed a systematic search for CEA studies of PCV15 and/or PCV20 on databases including PubMed, EMBASE, Cost-effectiveness analysis Registry by Tufts Medical Center, EconLit, International HTA Database, and National Immunization Technical Advisory Groups database through October 30, 2023. Study characteristics, methods, assumptions, and findings were extracted independently by two reviewers. Quality assessment was performed using the Ecobias tool. Results were synthesized qualitatively to summarize key attributes and conclusions.

RESULTS: Of 120 identified records, 19 studies were included; all concerned high-income countries except one in Argentina. All employed static Markov-type models comparing higher-valent PCVs used alone or in combination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) to current recommendations (e.g., PPSV23±13-valent PCV, etc.). Four studies derived vaccine effectiveness from Delphi panel estimates, whereas others assumed similar serotype-specific efficacy to the PCV13 pivotal adult RCT. Waning of protection varied among studies from 10 year to 20 years. The majority (14/19) of studies conclude that 20-valent PCVs were cost-saving (dominant) or cost-effective. Additionally, 58% (11/19) of studies included indirect effects that attenuate vaccine impact in the adult population such as herd effect from higher-valent PCVs in childhood (10/19) or serotype replacement (2/19). Only one study considered both indirect effects. Most studies were assessed as low risk of bias; two abstracts did not provide sufficient information for assessment.

CONCLUSIONS: Current evidence indicates that 20-valent PCV is likely to be cost-effective or dominate current adult pneumococcal strategies; policymakers should consider whether implementing such a program would improve health and lower total long-term costs due to pneumococcus.