Health Economic Analysis of Risk- and Age-Based Pneumococcal Vaccination With PCV21 vs. PCV20 in France
Author(s)
Oluwaseun Sharomi, BSc, MSc, PhD1, Manon Breau-Brunel, PharmD2, Robert Cohen, MD3, John Lang, BSc, MSc, PhD4.
1Merck & Co., Inc., Rahway, NJ, USA, 2MSD France, Puteaux, France, 3ACTIV, Association Clinique et Thérapeutique Infantile, Créteil, France, 4Merck Canada Inc, Kirkland, QC, Canada.
1Merck & Co., Inc., Rahway, NJ, USA, 2MSD France, Puteaux, France, 3ACTIV, Association Clinique et Thérapeutique Infantile, Créteil, France, 4Merck Canada Inc, Kirkland, QC, Canada.
OBJECTIVES: Pneumococcal vaccination with a 20-valent pneumococcal conjugate vaccine (PCV20) is recommended in France for at-risk adults and adults aged 65 years and more. A 21-valent adult-focused PCV (PCV21) has been developed, and protects against serotypes responsible for 86% of invasive pneumococcal disease (IPD) in adults (23 percentage points more than PCV20). This study evaluated the cost-effectiveness of PCV21 versus PCV20 vaccination among at-risk and older adults in France.
METHODS: A previously published age- and serotype-specific dynamic transmission model was adapted to the French setting to evaluate the impact of adult vaccination with PCV20 and PCV21. A pediatric vaccine coverage rate (VCR) of 95% was assumed (50:50 split PCV13:PCV15). VCRs for older adults(≥65-year-olds), high-risk(<65-year-old adults), and intermediate-risk(<65-year-old adults) were assumed to be 60%, 42%, and 20%, respectively. Model outcomes included IPD, non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae (PMS), deaths, antibiotic courses, PD management costs, vaccination acquisition and administration costs, and quality-adjusted life-years over a 65-year time-horizon. Costs(2024 euros) and QALYs were discounted 2.5% for the first 30 years, decaying to ~2% over the next 35 years. The per-dose acquisition costs (including €1.02 dispensation fee) were €83.46 for PCV21 and €59.26 for PCV20. Sensitivity analysis was performed to measure the robustness of the results.
RESULTS: Cumulatively, vaccination with PCV21 versus PCV20 resulted in a reduction of approximately 20,589 IPD cases, 644,676 NBPP cases, 265 PMS cases, 13,063 deaths, and 33,574 antibiotic courses over 65 years. Discounted vaccination costs were around €1.2 billion greater for PCV21, while PD management costs were €483 million lower, leading to overall costs increase of €720 million. Discounted QALYs were 12,236 greater for PCV21 versus PCV20, resulting in an ICER of €58,835/QALY gained.
CONCLUSIONS: Vaccination of at-risk adults and those aged 65 years and more with PCV21 is expected to be cost-effective compared to vaccination with PCV20 in France.
METHODS: A previously published age- and serotype-specific dynamic transmission model was adapted to the French setting to evaluate the impact of adult vaccination with PCV20 and PCV21. A pediatric vaccine coverage rate (VCR) of 95% was assumed (50:50 split PCV13:PCV15). VCRs for older adults(≥65-year-olds), high-risk(<65-year-old adults), and intermediate-risk(<65-year-old adults) were assumed to be 60%, 42%, and 20%, respectively. Model outcomes included IPD, non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae (PMS), deaths, antibiotic courses, PD management costs, vaccination acquisition and administration costs, and quality-adjusted life-years over a 65-year time-horizon. Costs(2024 euros) and QALYs were discounted 2.5% for the first 30 years, decaying to ~2% over the next 35 years. The per-dose acquisition costs (including €1.02 dispensation fee) were €83.46 for PCV21 and €59.26 for PCV20. Sensitivity analysis was performed to measure the robustness of the results.
RESULTS: Cumulatively, vaccination with PCV21 versus PCV20 resulted in a reduction of approximately 20,589 IPD cases, 644,676 NBPP cases, 265 PMS cases, 13,063 deaths, and 33,574 antibiotic courses over 65 years. Discounted vaccination costs were around €1.2 billion greater for PCV21, while PD management costs were €483 million lower, leading to overall costs increase of €720 million. Discounted QALYs were 12,236 greater for PCV21 versus PCV20, resulting in an ICER of €58,835/QALY gained.
CONCLUSIONS: Vaccination of at-risk adults and those aged 65 years and more with PCV21 is expected to be cost-effective compared to vaccination with PCV20 in France.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE488
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Value of Information
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Vaccines