Cost-Effectiveness of 20-Valent Pneumococcal Conjugate Vaccine in Singaporean Adults Aged ≥18 Years

OBJECTIVES: The Singapore Ministry of Health (MOH) recommends pneumococcal vaccination—13-valent pneumococcal conjugate vaccine (PCV13) or 23-valent pneumococcal polysaccharide vaccine (PPSV23)—in adults aged 18-64 years with chronic medical (“at-risk”; 1 dose PPSV23) or immunocompromising (“high-risk”) conditions (PCV13+PPSV23, revaccination with PPSV23 5 years later), and all adults aged ≥65 years (PCV13+PPSV23). With the recent licensure of 20-valent PCV (PCV20), we conducted a cost-effectiveness analysis (CEA).

METHODS: A probabilistic cohort model was developed to project the lifetime risks and costs of invasive pneumococcal disease (IPD), all-cause nonbacteremic pneumonia (NBP), and the expected impact of vaccination. Clinical outcomes were projected on an annual basis based on current epidemiology and age/risk profile. Economic costs were estimated based on cases and corresponding medical costs (discounting, 3%/year). Costs of vaccine and administration were tallied at time of receipt. Cost per quality-adjusted life year (QALY) gained with PCV20 (vs. current recommendations) was assessed among at-risk adults aged 18-64 years, high-risk adults aged 18-64 years, and all adults aged ≥65 years, separately and collectively; a healthcare system perspective was used.

RESULTS: PCV20 was estimated to reduce IPD cases by 42, NBP cases by 2,982, deaths by 207 in at-risk/high-risk population aged 18-64 years and all adults aged ≥65 years (N=1.6 million). Estimated overall net costs (including vaccination and medical costs) were lower by SGD 0.7 million, making PCV20 dominant versus current strategies. In the age- and risk-specific subgroups, replacing PCV13 with PCV20 was dominant among high-risk adults aged 18-64 years and all adults ≥65 years; among at-risk adults aged 18-64 years, cost/QALY was SGD 3,329.

CONCLUSIONS: CEA suggests that use of PCV20—in lieu of current recommendations by the Singapore MOH among at-/high-risk adults aged 18-64 years and all adults aged 65-99 years—would yield overall cost savings and represent a cost-effective use of scarce healthcare resources.