Presentation (CTI)

OBJECTIVES: This study aimed to assess the cost-utility of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) for disease prevention among adults aged 50 and older in Colombia.
METHODS: We used a decision tree model because it provides a clear and comprehensible visual framework for comparing six strategies: no intervention (NI), single-dose PCV13, single-dose PPSV23, PCV13+PPSV23 (PPSV23 administered eight weeks after PCV13), PPSV23+PPSV23 (PPSV23 booster dose at five years), and PCV13+PPSV23+PPSV23. We evaluated clinical and economic outcomes for community-acquired pneumonia (CAP), invasive pneumococcal disease (IPD) (meningitis and bloodstream infections), and complications such as major adverse cardiovascular events and antimicrobial resistance. We obtained clinical parameters from the CAPITA trial (PCV13) and a WHO-funded meta-analysis (PPSV23). Costs were estimated based on healthcare resource utilization reported by a nationwide health insurer. The model adopted a five-year time horizon and applied a 5% annual discount rate. Prices were expressed in 2024 USD, using an exchange rate of 4,200 COP per USD. We calculated incremental cost-effectiveness ratios (ICERs) for each strategy. We conducted a heterogeneity analysis by subgroups based on four age groups (50-64, 65-74, 75-84, >85 years), along with 1,000 Monte Carlo simulations and the construction of willingness-to-pay (WTP) curves based on a GDP per capita of $7,170.
RESULTS: Strategies including PCV13 were cost-saving compared to NI and PPSV23 (ICER for PPSV23: $39,355; PPSV23+PPSV23: $18,841). Single-dose PCV13 strategy saves $277,4 million vs NI. WTP curves showed that NI, PPSV23, and PPSV23+PPSV23 had a 0% probability of being cost-effective across age groups. PCV13+PPSV23 had a 68.1% probability of being the best vaccination strategy.
CONCLUSIONS: PCV13 vaccination is a cost-saving strategy for preventing pneumococcal disease in Colombians aged 50 and older. It is attributed to its high efficacy in preventing CAP, the most common pneumococcal disease, and its cost savings in reducing healthcare expenditures on pneumococcal diseases and complications.