Cost-Effectiveness Analysis of Pediatric and Adult Pneumococcal Conjugate Vaccine Strategies in Canada
Author(s)
Michele Wilson, MSPH, PhD1, Gokul Raj Pullagura, PharmD, PhD2, Sean Weicker, MSc3, Sophie Warren, MSc4.
1Senior Director, Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA, 2Pfizer Canada ULC, Kirkland, QC, Canada, 3Pfizer Canada, Kirkland, QC, Canada, 4Pfizer, North Reading, MA, USA.
1Senior Director, Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA, 2Pfizer Canada ULC, Kirkland, QC, Canada, 3Pfizer Canada, Kirkland, QC, Canada, 4Pfizer, North Reading, MA, USA.
OBJECTIVES: In Canada, PCV15 (Vaxneuvance) and PCV20 (Prevnar 20) are approved for use in adult and pediatric populations. PCV21 (Capvaxive) is approved only for use in adults. PCV15 and PCV20 are nationally recommended for childhood vaccination, but only PCV15 is funded. PCV20 and PCV21 are nationally recommended for adult vaccination, but PCV20 is most commonly funded. In 2026, policymakers must decide whether to 1) maintain PCV15 in the pediatric program or switch to PCV20, and 2) maintain PCV20 in the adult program or switch to PCV21. This analysis estimated the cost effectiveness of using PCV15 for children and PCV21 for adults (“PCV15/PCV21” strategy) versus using PCV20 for both programs (“PCV20 for all” strategy) starting in 2026.
METHODS: A decision-analytic model estimated the public health and economic impact of PCV20 for all versus PCV15/PCV21 over 5 years in Canada. Age-specific clinical and economic inputs were obtained from published sources. Direct and indirect effects for pediatric vaccines were based on observed reductions in IPD incidence following PCV13 implementation. Direct effects for adult vaccines were assumed equal to PCV13 efficacy from the CAPiTA trial. The model estimated costs, quality-adjusted life-years (QALY), and cases of invasive pneumococcal disease (IPD), pneumonia, and otitis media (OM) for each strategy.
RESULTS: Over 5-years, PCV20 for all could avert an additional 994 IPD cases, 27,193 pneumonia cases, and 17,961 OM cases across all ages compared to PCV15/PCV21. In addition, PCV20 for all reduced costs by $137,527,079 CAD compared to PCV15/PCV21 and was thus the dominant (more effective and cost-saving) strategy.
CONCLUSIONS: Funding PCV20 for both pediatric and adult public immunization programs could result in greater health and economic gains than funding PCV15 in pediatric and PCV21 in adult programs. Additionally, using one vaccine for all ages could enhance equity, simplify vaccine procurement, and improve logistical inefficiencies related to training, supply, and storage.
METHODS: A decision-analytic model estimated the public health and economic impact of PCV20 for all versus PCV15/PCV21 over 5 years in Canada. Age-specific clinical and economic inputs were obtained from published sources. Direct and indirect effects for pediatric vaccines were based on observed reductions in IPD incidence following PCV13 implementation. Direct effects for adult vaccines were assumed equal to PCV13 efficacy from the CAPiTA trial. The model estimated costs, quality-adjusted life-years (QALY), and cases of invasive pneumococcal disease (IPD), pneumonia, and otitis media (OM) for each strategy.
RESULTS: Over 5-years, PCV20 for all could avert an additional 994 IPD cases, 27,193 pneumonia cases, and 17,961 OM cases across all ages compared to PCV15/PCV21. In addition, PCV20 for all reduced costs by $137,527,079 CAD compared to PCV15/PCV21 and was thus the dominant (more effective and cost-saving) strategy.
CONCLUSIONS: Funding PCV20 for both pediatric and adult public immunization programs could result in greater health and economic gains than funding PCV15 in pediatric and PCV21 in adult programs. Additionally, using one vaccine for all ages could enhance equity, simplify vaccine procurement, and improve logistical inefficiencies related to training, supply, and storage.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE215
Topic
Economic Evaluation
Disease
Vaccines