OBJECTIVES: The Philippines national immunization program (NIP) included the use of 23-valent pneumococcal polysaccharide vaccine (PPV23) for adults ≥60 years. Additionally, the local clinical practice guidelines recommended to use 13-valent pneumococcal conjugate vaccine (PCV13) or PPV23 in adults aged ≥50 years who are at elevated risk of pneumococcal disease due to chronic medical or immunocompromising conditions. To assess the economic implications of PCV13 use versus PPV23 (with revaccination 5 years later), we conducted a cost-effectiveness analysis (CEA) in adults aged 50-59 years with elevated risk and all adults aged ≥60 years.

METHODS: A probabilistic cohort model was developed to project the lifetime risks and costs of invasive pneumococcal disease (IPD), all-cause non-bacteremic pneumococcal pneumonia (NBPP), and expected impact of vaccination. Clinical outcomes were projected on an annual basis based on current epidemiology and age/risk profile. Economic costs were estimated based on cases and corresponding medical, non-medical and vaccination costs. Costs and benefits were discounted at a rate of 7%/year. Cost per quality-adjusted life year (QALY) gained was evaluated from the healthcare system and societal perspectives.

RESULTS: Compared with 2 doses of PPSV23 (revaccination 5 years later), one-dose of PCV13 was estimated to reduce additional IPD cases by 832, NBPP cases by 1,093, and deaths by 376 among adults aged 50-59 with elevated risk and all adults aged ≥60 years (N=12.8 million). From the healthcare perspective (considering medical and vaccination costs only), net costs were estimated to be ₱33.6 million yielding a cost/QALY of ₱31,791; from the societal perspective (including non-medical costs), the cost/QALY was estimated to be ₱25,308.

CONCLUSIONS: CEA suggests that, compared with the current recommendation, using one dose of PCV13 in adults aged 50-59 years with elevated risk and all adults aged ≥60 years in the Philippines would be cost-effective based on one time GDP per capita threshold.