A Public Health and Budget Impact Analysis (BIA) of Vaccinating Adults Older 60 Years and Risk-Groups Against Pneumococcal-Diseases in Austria

OBJECTIVES: Infection with Streptococcus pneumoniae can cause noninvasive and invasive pneumococcal disease (IPD), leading to about 2 million deaths annually worldwide. Vulnerable groups include adults 60+ and those 18+ with chronic conditions like COPD, diabetes, and cardiovascular disease (CVD), for whom vaccination is recommended. In Austria, around 30,000 adults get pneumococcal infections annually, with 20,000 cases linked to PPV23 and/or PCV15/20 serotypes, and about 340 developing IPD. This budget impact analysis (BIA) compares the effects of vaccinating a portion of older and at-risk adults with PPV23 or PCV15/20 vaccines versus no vaccination, quantifying the positive financial impact.

METHODS: A 5-year, multi-cohort, population-based model was developed, including states of hospitalized and outpatient pneumococcal diseases (S. pneumoniae), IPD, complications, and mortality. In the vaccination arm, 16% of adults aged 60+ and 20% of at-risk patients are vaccinated in the first year, rising to 20% and 28% by year five. The model accounts for serotype shifts over time. Results show savings for the healthcare-system and society. Vaccination costs are based on the pharmacy selling price and are paid out-of-pocket.

RESULTS: At the current vaccination rate for those 60+, pneumococcal vaccination saves €21.3 million over 5 years. The highest savings are in the CVD risk-group (€15.6 million), followed by COPD GOLD II+ patients (€13.6 million). The highest return-on-investment exhibits for COPD GOLD III+ patients, every €1 privately invested in vaccination saves society €5.62 and the healthcare-system €5.34.

In the 60+ age group, vaccination prevents 9,760 pneumonias and 83 IPDs, followed by the CVD risk-group with 4,509 pneumonias and 149 IPDs prevented. The greatest reduction in lost workdays is among those 60+ (6,992 days) and diabetes patients (5,953 days).

CONCLUSIONS: Pneumococcal vaccination saves money for both society and the healthcare system. Including it in a public co-payment program would boost vaccination rates, especially among vulnerable groups, and increase savings.