OBJECTIVES : On 31 March 2020, the Danish Parliament decided to offer free vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) to all persons aged 65 and above and to individuals at an increased risk of pneumococcal disease. The aim of this study was to evaluate the impact of pneumococcal vaccination on individuals in their fifties by modelling the health economic consequences of an extension of the programme to include individuals aged 50-54 and 55-59.

METHODS : We adapted a Markov model to a Danish healthcare setting to simulate the incidence, costs, and mortality of non-bacteremic pneumococcal pneumonia (NBPP), invasive pneumococcal disease (IPD), and post-meningitis sequalae in a period of five years with and without PPSV23 vaccination.

RESULTS : We found that an extension of the Danish age-based PPSV23 programme to include persons aged 55-59 would lead to saved costs of EUR 521,792 over a five-year period per 1 million persons in this age group. Moreover, this would lead to the prevention of 461 cases of IPD, 2,700 cases of NBPP and 83 pneumococcus-related deaths.

Similarly, an additional extension of the programme to include persons aged 50-54 would prevent 263 cases of IPD, 1,894 cases of NBPP and 45 pneumococcus-related deaths per 1 million persons in this age group over a five-year period. Moreover, for this age group this implies an incremental societal cost of EUR 9.8 million, corresponding to a net cost of EUR 4,541 per avoided case of pneumococcal disease.

CONCLUSIONS : When considering an extension of the Danish age-based PPSV23 vaccination programme, we show that inclusion of persons aged 55-59 leads to health gains, reduced mortality and reductions in healthcare resource utilization. An additional extension to include persons in the age group 50-54 has a net cost of EUR 4,541 per avoided case of pneumococcal disease.