COST EFFECTIVENESS ANALYSIS OF ADULT PNEUMOCOCCAL VACCINES INCLUDING PCV21 AND PCV20 TO OPTIMIZE NATIONAL IMMUNIZATION PROGRAM IN JAPAN
Author(s)
Ataru Igarashi, PhD1, Ayako Shoji, PhD2, Hiroshi Yoshihara, BS, MS2, Yuriko Hagiwara, PhD, MSc.2;
1The Univeristy of Tokyo, Dept of Public Health and Health Policy, Tokyo, Japan, 2The University of Tokyo, Dept of Public Health and Health Policy, Tokyo, Japan
1The Univeristy of Tokyo, Dept of Public Health and Health Policy, Tokyo, Japan, 2The University of Tokyo, Dept of Public Health and Health Policy, Tokyo, Japan
OBJECTIVES: In Japan, the introduction of PCV20 into routine vaccination was discussed by the national vaccine advisory committee and generally found to be more cost-effective than no vaccination or existing strategies. However, PCV21 was not included in the most recent evaluation in 2025. While PCV20 is scheduled for routine use, PCV21 has been adopted or considered in other countries. Therefore, this study evaluates and compares PCV20 and PCV21 in the Japanese context, taking into account country-specific serotype trends.
METHODS: A Markov model was constructed from the healthcare payer perspective. Vaccine effectiveness was evaluated using quality-adjusted life years (QALYs) and life years gained. A total of 500,000 microsimulations were conducted, and costs and outcomes were discounted at an annual rate of 2%. Model parameters were derived from recent meta-analyses, randomized controlled trials, and publicly available governmental data. Vaccine efficacy against IPD and non-bacteremic pneumonia was estimated using age-specific hazard ratios from a randomized controlled trial by Van Werkhoven et al., while PPSV23 effectiveness was based on a recent meta-analysis.
RESULTS: Under the current National Immunization Program (type B) with public funding for individuals aged 65 years and older, both PCV20 and PCV21 were cost-effective compared with the existing PPSV23 program and with no vaccination. Across all age scenarios evaluated (all ages, and vaccination at 65, 70, 75, and 80 years), both PCV20 and PCV21 were dominant over PPSV23. Moreover, PCV21 was dominant over all alternative strategies, including PCV20, PPSV23, and no vaccination.
CONCLUSIONS: This study has several limitations. Most notably, there is a lack of robust real-world effectiveness data for PCV20-covered serotypes, particularly serotype 3, which remains highly prevalent in adult IPD. Given the extensive assumptions required, optimization of routine pneumococcal vaccination policies should be guided by the most recent and locally relevant epidemiological evidence.
METHODS: A Markov model was constructed from the healthcare payer perspective. Vaccine effectiveness was evaluated using quality-adjusted life years (QALYs) and life years gained. A total of 500,000 microsimulations were conducted, and costs and outcomes were discounted at an annual rate of 2%. Model parameters were derived from recent meta-analyses, randomized controlled trials, and publicly available governmental data. Vaccine efficacy against IPD and non-bacteremic pneumonia was estimated using age-specific hazard ratios from a randomized controlled trial by Van Werkhoven et al., while PPSV23 effectiveness was based on a recent meta-analysis.
RESULTS: Under the current National Immunization Program (type B) with public funding for individuals aged 65 years and older, both PCV20 and PCV21 were cost-effective compared with the existing PPSV23 program and with no vaccination. Across all age scenarios evaluated (all ages, and vaccination at 65, 70, 75, and 80 years), both PCV20 and PCV21 were dominant over PPSV23. Moreover, PCV21 was dominant over all alternative strategies, including PCV20, PPSV23, and no vaccination.
CONCLUSIONS: This study has several limitations. Most notably, there is a lack of robust real-world effectiveness data for PCV20-covered serotypes, particularly serotype 3, which remains highly prevalent in adult IPD. Given the extensive assumptions required, optimization of routine pneumococcal vaccination policies should be guided by the most recent and locally relevant epidemiological evidence.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE301
Topic
Economic Evaluation
Disease
STA: Vaccines