OBJECTIVES: In Hong Kong, the Scientific Committee on Vaccine Preventable Disease (SCVP) recommended either 1-dose of 13-valent pneumococcal vaccination (PCV13) or 1-dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults aged ≥ 65 years and an additional dose of PCV13 or PPSV23 for individuals with risk conditions (chronic or immunocompromising disease). The 20-valent PCV (PCV20) was recently approved. We conducted a cost-effectiveness analysis (CEA) to assess the value of replacing PCV13 with PCV20.

METHODS: Based on current epidemiology and age/risk profiles in Hong Kong, a probabilistic cohort model was developed to estimate impact of replacing PCV13 with PCV20 on invasive pneumococcal disease (IPD), all-cause nonbacteremic pneumonia (NBP), and corresponding medical and vaccination costs. Cost per quality-adjusted life year (QALY) gained was assessed in adults aged ≥ 65 years and in adults aged 18-64 years with risk conditions collectively and separately from both payer and societal perspectives (discounting, 4%/year).

RESULTS: Replacing PCV13 with PCV20 was dominant in aged ≥ 65 years (N=1.38 million) and was estimated to reduce IPD cases, all-cause NBP and death by 2, 915, and 39, respectively and the overall net cost by $HK195k (payer) and $HK198k (societal). Including adults aged 18-64 years with risk conditions together with aged ≥ 65 years (N=3.19 million), replacing PCV13 with PCV20 was also dominant and was estimated to reduce IPD cases by 6, all-cause NBP by 1,572, deaths by 75 and the overall net cost by $HK311k (Payer) and $HK330k (Societal). In the age- and risk-specific subgroups, replacing PCV13 with PCV20 was dominant among adults aged 18-64 years or among adults aged ≥ 65 years with risk conditions.

CONCLUSIONS: CEA suggests that replacing PCV13 with PCV20 in adults—in lieu of current recommendations by the Hong Kong SCVP would yield overall cost savings and represents a cost-effective use of scarce healthcare resources.