OBJECTIVES: Invasive pneumococcal disease (IPD) and non bacteremic pneumococcal pneumonia (NBPP) represent an important health problem among older adult population. Currently, in Spain the use of PPV23 is recommended for all individuals above 65 years and for individuals with certain chronic diseases, and, in addition, the use of PCV13 is recommended for those with immunosuppression and with specific underlying conditions. This study was aiming to estimate the incremental cost-effectiveness ratio (ICER) of vaccinating immunocompetent adults aged 60+ with PPV23 compared to a sequential vaccination strategy (PCV13-PPV23).

METHODS: A Markov model was adapted to the Spanish healthcare setting to simulate incidence and consequences of NBPP and IPD. Parameters such as vaccine effectiveness, disease incidence, utilities, and costs were based on published data. The analysis was conducted from the perspective of the Spanish National Healthcare System (SNHS), with a lifetime horizon. Waning effect over time was considered for both vaccines’ effectiveness. Outcomes and costs were both discounted at 3% annually. Official list prices were used in the base case. Deterministic sensitivity analyses (DSA) were performed to explore the impact of parametric uncertainty. Additionally, the analysis assessed the ICER of starting vaccination at the age of 60 vs 65 with different strategies.

RESULTS: The sequential vaccination strategy would prevent 3,340 cases of IPD, 14,451 cases of NBPP and 2,417 deaths related to pneumococcal disease compared to the PPV23 strategy. The sequential strategy presented a larger number of quality-adjusted life-years (QALYs) compared to PPV23 alone but also increased the total costs by more than €218 million, resulting an ICER of €42,259 per QALY gained.

CONCLUSIONS: A sequential vaccination strategy of immunocompetent adults aged 60+ with PCV13-PPV23 would result in an improvement in health outcomes, but at a cost exceeding typical cost-effective benchmarks for Spain, compared to PPV23 alone.