Objectives. US Advisory Committee on Immunization Practices (ACIP) recently updated adult pneumococcal immunization recommendations to include routine use of 20-valent pneumococcal conjugate vaccine (PCV20) alone or sequentially administered 15-valent PCV (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PCV15→PPSV23). We evaluated the budgetary impact of PCV20 alone and, alternatively, PCV15→PPSV23 compared with previous recommendations (i.e., age/risk dependent use of PPSV23 alone or 13-valent PCV followed by PPSV23 [PCV13→PPSV23]).

Methods. Analyses were conducted using deterministic model to depict risks and costs of pneumococcal disease among US adults aged 19-64 years with underlying medical conditions and all adults aged 65-99 years (N=10M). Persons in model population were vaccinated at model entry or in subsequent years, or were never vaccinated. Clinical outcomes included invasive pneumococcal disease (IPD), inpatient and outpatient all-cause non-bacteremic pneumonia (NBP), and disease-related deaths. Economic costs included disease-related medical care and vaccination (acquisition and administration). Budgetary impact of new (vs. previous) recommendations was calculated as difference in total costs over a 5-year period.

Results. Compared with previous recommendations, PCV20 alone would prevent an additional 345 IPD cases, 1,956 inpatient and 2,834 outpatient NBP cases, and 156 disease-related deaths; with medical costs lower by $59.0M and vaccine costs higher by $120.0M, total budget impact was $61.0M overall or $0.52 per-member per-month (PMPM). Use of PCV15→PPSV23 in lieu of PCV20 alone would prevent fewer cases and deaths (191 IPD, 1,219 inpatient NBP, 1,813 outpatient NBP, and 91 deaths, vs. previous recommendations); with higher medical ($36.0M) and vaccination ($433.7M) costs, the total budgetary impact of PCV15→PPSV23 would also be higher ($397.7M overall or $3.42 PMPM).

Conclusion. Both vaccination strategies included in new US ACIP pneumococcal immunization guidelines prevent additional cases of disease and disease-attributable deaths compared with previous recommendations. PCV20 alone, however, prevents more disease and deaths than the costlier alternative strategy involving PCV15→PPSV23.