OBJECTIVES

: Following the introduction of childhood pneumococcal immunization programs, substantial herd benefits among unvaccinated populations (including older adults) have been observed. However due to serotype replacement, most of the serotypes affecting older adults are non-vaccine serotypes. Adults with comorbidities are significantly less likely to suffer from community-acquired pneumonia (CAP) from serotypes covered by 13-valent pneumococcal conjugate vaccine (PCV13) as compared to non-PCV13 serotypes. Currently, PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) are available for use in older adults. The objective of this systematic literature review was to summarize published cost-effectiveness analyses and recommendations for pneumococcal vaccines in adults >50 years of age in Europe.

METHODS

: We performed structured searches of literature published in English between January 2010 and February 2019 in PubMed and Embase databases. References cited in the eligible publications were also screened.

RESULTS

: We retrieved 9 eligible publications, including 1 abstract. In 3 of 4 publications, PPSV23 was found cost-effective versus no vaccination (in 1 out of 2 industry-independent publications). In all 3 industry-independent eligible publications, PCV13 was not found to be cost-effective either versus no vaccination or versus PPSV23. In 4 other publications, PCV13 was found to be cost-effective: the comparator was PPSV23 in 2 publications and no vaccination in 3 publications. The indirect impact of infant vaccination was not consistently considered across publications and affected the findings.

CONCLUSIONS

: Our systematic review highlights that PPSV23 was cost-effective against pneumococcal disease in older adults in most settings. The cost-effectiveness of PCV13 in older adults is debatable, since it depends on specific assumptions. Results from these studies should be interpreted with caution.