A Budget Impact Analysis of Newer Pneumococcal Conjugate Vaccine Use in All US Adults Aged 50-64 Years Old Compared to Current Recommendations from US Payer Perspective

BACKGROUND: Recently, the US CDC recommended 20-valent pneumococcal conjugate vaccine (PCV20) or 15-valent pneumococcal conjugate vaccine (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65-years and older and those aged 19-64 years old with chronic conditions. However, there is a substantial pneumococcal disease burden in healthy adults aged 50-64 years, particularly in Black populations, and they are likely to benefit from pneumococcal vaccination. This study assesses the financial impact of introducing newer pneumococcal conjugate vaccines in all US adults aged 50-64 years.

OBJECTIVES: To evaluate the budget impact, from the US payer perspective, of introducing PCV20 or PCV15/PPSV23 use in all adults aged 50-64-years-old compared to current recommendations for pneumococcal vaccination only in 50-64-year-olds with chronic conditions.

METHODS: A budget impact model was developed over a 3-year time horizon. Outcomes and costs of pneumococcal disease among all US adults aged 50-64 years and those with underlying conditions were projected using a Markov decision model. Hypothetical vaccination with PCV20 versus PCV15/PPSV23 was compared from the US payer perspective. Sensitivity analyses considered demographic and disease differences in Black versus non-Black, vaccination program coverage, vaccine effectiveness, disease burden and associated cost variance in a target vaccine population aged 50-64 years.

RESULTS: Incorporating either PCV20 or PCV15/PPSV23 vaccines in universal immunization programs for adults aged 50-64 years compared to immunizing only those adults with chronic conditions had an incremental budget impact of $6.5 billion and $9 billion respectively over three years. Budgetary impact was sensitive to vaccine doses, vaccine coverage and pneumococcal treatment cost across overall population and sub-groups. Vaccinating all general population 50-year-olds was more economically favorable in Black population sub-group analyses.

CONCLUSIONS: Study results will inform decision-makers in the policy of pneumococcal vaccination program for all US adults aged 50-64 years.