OBJECTIVES: In 2018, a 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the national immunization program for adults aged ≥60 years in Peru. This study evaluated the cost-effectiveness of a vaccination strategy with 23-valent pneumococcal polysaccharide vaccine (PPSV23) alone compared to PCV13 for adults aged ≥60 years from the perspective of the Peruvian public health system.

METHODS: A published Markov model was used to estimate costs and health outcomes (i.e., invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP)) of a Peruvian cohort of adults aged ≥60 years. The population was divided into healthy (52.6%), at risk (37.4%), and high-risk (10%) for pneumococcal disease. Five health states were considered: no disease, IPD, NBPP, post-meningitis sequelae (PMS), and death. The model assumed 1-year cycle length, a 10-year time horizon, a 30% vaccine uptake, and annual discount rate of 5% for the health and costs. The PCV13 vaccine effectiveness for IPD and NBPP were 75% and 45% and for PPSV23 were 73% and 33.5%, respectively. Vaccine acquisition costs were US$ 13.50 for PCV13 and US$ 9.44 for PPSV23. Disease costs and epidemiological parameters were obtained from Peruvian-specific data sources; where not available, regional data was used. Costs were converted into June 2023 US dollars (exchange rate 1 US$= 3,65 soles).

RESULTS: Among a cohort of 4.5 million adults aged ≥60 years, vaccination with PPSV23 was projected to avert 263 cases of pneumococcal disease (22 NBPP and 241 IPD including 36 meningitis cases), 130 deaths (129 IPD and 1 NBPP) and to gain 655 life years compared with PCV13. PPSV23 dominated PCV13 with a total cost savings of US$ 10.3 million.

CONCLUSIONS: Under model assumptions, PPSV23 was a dominant strategy over PCV13 in adults aged ≥60 years in Peru, leading to better health outcomes and cost savings of US$ 10.3 million.