OBJECTIVES: This study compares the health gains and economic consequences of introducing a PPSV23-based vaccination program for all individuals 65+ versus a strategy of no vaccination. Since June 2020, all adults 65+ in Denmark are offered vaccination against pneumococcal disease with a 23-valent polysaccharide vaccine (PPSV23). The health authorities have an ambition of reaching a vaccination coverage rate (VCR) of 75% within the first year. Based on local data (2017) on invasive pneumococcal disease (IPD) serotype distribution, PPSV23 is reported to cover 73% of all IPD cases in adults 65+.

METHODS: A Markov model was adapted to the Danish healthcare settings to simulate incidence and consequences of IPD and non-bacteremic pneumococcal pneumonia (NBPP) in adults 65+ over a 5-year period with a VCR of 75%. Input data was based on local data from Danish health authorities and international publications. A vaccine efficacy of 73% and 33%, with a linear 5-year waning, for vaccine type IPD and NBPP, respectively, was applied. Five health states were considered in the model: No pneumococcal disease, IPD, NBPP, post-meningitis sequelae and death.

RESULTS: Over a 5-year period, implementing a PPSV23-based program for adults 65+ would prevent 625 and 17,177 cases of IPD and NBPP, respectively. Furthermore, over the same time period the program would prevent 141 and 1150 deaths due to IPD and NBPP, respectively. This implies a gain of 18,204 disease-free life-years and a reduction of 52 million Euro (discounted) in healthcare costs.

CONCLUSIONS: The results show that implementing a single dose PPSV23-based vaccination program for adults 65+, irrespective of additional risk-factors, leads to health gains, reduced mortality and reductions in healthcare resource utilization.