OBJECTIVES: In India, one dose of 23-valent pneumococcal polysaccharide vaccine (PPV23) has been recommended for adults aged ≥65 years. For adults ≥60 years at elevated risk (with chronic [“at-risk”] or immunocompromising [“high-risk”] conditions), based on clinical judgement, one dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by PPV23 has been recommended. To simplify the recommendation, we conducted a cost-effectiveness analysis (CEA) comparing one dose of PCV13 versus one dose of PPV23 among all Indian adults ≥60 years.

METHODS: Based on current epidemiology, age/risk profile and the expected impact from direct vaccination, a probabilistic cohort model was developed to project lifetime cases, deaths, and medical costs associated with invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP) (discounting, 5%/year). Cost per quality-adjusted life year (QALY) gained was assessed from the private/patient and government/payer perspectives, which differed primarily on medical care costs, vaccine price, administration costs, and uptake rates (private/patient: 7.5% among all; government/payer: 7.5%, 15% and 30% among healthy, at-risk, and high-risk, respectively).

RESULTS: Among 145.6 million Indian adults, from the private/patient perspective, replacing PPV23 with PCV13 was estimated to reduce IPD cases by 4,600, all-cause NBP cases by 242,955, and deaths by 9,464. Net costs (including medical and vaccination costs) were estimated to be lower by ₹2.7 billion, thus making PCV13 the dominant strategy. From the government/payer perspective, reductions were 10,640 for IPD, 531,563 for all-cause NBP and 22,199 for deaths. Net costs were estimated to be ₹37.7 billion, yielding a cost/QALY of ₹417,458.

CONCLUSIONS: CEAs suggested that replacing PPV23 with PCV13 among adults aged ≥60 years would be cost-saving from the private/patient perspective and would be cost-effective, depending on the willingness-to-pay threshold, from the government/payer perspective. Considering the burden of pneumococcal disease and the current pneumococcal vaccine coverage, further evaluation of adult pneumococcal vaccination strategies in India is warranted.