OBJECTIVES: Mexico currently recommends the 13-valent pneumococcal conjugate vaccine (PCV13) in sequence with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) (i.e. standard of care – SoC) for adults 60 years and older, including adults with chronic medical (i.e. subjects at risk) or immunocompromised conditions (i.e. subjects at high risk). With upcoming PCV20, this study examined the cost-effectiveness of the potential replacement of PCV13-PPSV23 by a single dose of PCV20 in Mexican adult population.

METHODS: A Markov cohort model was adapted to the Mexican settings to compare clinical and economic impacts of PCV20 versus sequential vaccination PCV13-PPSV23 over a lifetime horizon from a payer perspective. The epidemiological, cost and clinical inputs were informed by Mexican specific sources. Vaccine effectiveness against vaccine-type invasive pneumococcal disease (VT-IPD) and all-cause non-bacteremic pneumonia (VT-NBP) for healthy and adults with risk conditions was estimated from PCV13/PPSV23 clinical effectiveness and the disease impact observed in Mexico. A 5% discounting rate was applied to both clinical and economic benefits.

RESULTS: The results suggested that a single dose of PCV20 would provide greater clinical impact compared to the current recommendation for pneumococcal vaccination in ≥60-year-olds in Mexico by reducing burden from PD (i.e. averting 28 bacteremia and 17 meningitis cases, 6,765 inpatient NBP and 13,607 outpatient NBP cases and 991 deaths due to diseases). This would potentially lead to a total QALYs and LYs gained of 6,370 and 5,804, respectively, and a cost saving of 2,355,022 Mexican peso ($MXN) over a lifetime horizon, implying PCV20 being a dominant strategy.

CONCLUSIONS: Overall, the introduction of a single dose of PCV20 in adults aged 60+ was estimated to dominate the current SoC (PCV13-PPSV23) in Mexico. Therefore, it is expected to be cost-saving and a sustainable vaccination option while preventing more clinical burden from pneumococcal infection.