OBJECTIVES : The Caja Costarricense del Seguro Social (CCSS) is the main Public Health Provider in Costa Rica, with a coverage around 92% of population1. Adults today, are vaccinated with 13-valent conjugated vaccine (PCV13) (1,090 per year), only if they are high-risk patients or health care professional with direct patient contact². Coverage in children with PCV13 is 96.8%³. By 2019, the population ≥60 years was around 647,000⁴. This study evaluates the economic impact of PCV13 on the prevention of community acquired pneumonia (CAP) in adults ≥60 years treated inpatient and outpatient in CCSS.

METHODS : A cohort of 647,000 adults ≥60 years of CCSS, was analyzed clinically and economically using a decision model, based on CCSS´s health and cost experience with patients that suffered CAP during 2011-2017^3,4. Average inpatient cost was $10,580 per case (11.6 inpatient-days) and outpatient average cost was $155.47^3,4.PCV13 is purchased by revolving fund of the Pan American Health Organization (PAHO). PCV13 effectiveness was calculated using published literature⁵. Model´s vaccination strategy analyzed 4 coverage scenarios: 30%; 50%; 70%; 100% of the initial cohort. From 2^nd year and subsequent, patients not vaccinated in 1^st cohort were distributed proportionally. The horizon was 7 years.

RESULTS : PCV13 vs no vaccination demonstrate to be a cost saving strategy in all scenarios, nevertheless, the overall economic and health benefits could be accomplished earlier if the starting population coverage is higher. In year 4 and subsequent, the annual investment on vaccination strategy is lower than treatment cost (variation: $-74,046; $-911,344; $-1,375,144; $-1,748,642 and $-3,004,589 in 30%; 50%; 70% and 100% of coverage, respectively). The accumulated savings at the end of analysis horizon were: $-4,411,767; $-6,471,484; $-8,531,201 and $-11,620,777 in 30%; 50%; 70% and 100% of coverage, respectively.

CONCLUSIONS : PCV13 is cost saving strategy for adults ≥60 years in CCSS versus no vaccination