Abstract

Objectives

The Singapore Ministry of Health recommends vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults aged 18 to 64 years with chronic medical conditions (“at risk”), 13-valent pneumococcal conjugate vaccine (PCV13) followed by PPSV23 (PCV13 → PPSV23) with PPSV23 revaccination in adults aged 18 to 64 years with immunocompromising conditions (“high risk”), and PCV13 → PPSV23 in all adults aged ≥65 years. We conducted a cost-effectiveness analysis of the newly licensed 20-valent PCV (PCV20) versus current recommendations.

Methods

Risks and costs of invasive pneumococcal disease, all-cause nonbacteremic pneumonia, and the expected impact of vaccination were projected over a lifetime modeling horizon using a probabilistic cohort model. Model inputs were based on local data, as available. Cost per quality-adjusted life year (QALY) gained with PCV20 (vs current recommendations) was assessed overall and among subgroups of the target population from a healthcare system perspective (discounting, 3%/year). Sensitivity analyses were also conducted.

Results

PCV20 was estimated to reduce invasive pneumococcal disease cases by 41, nonbacteremic pneumonia cases by 4335, and deaths by 196 among the model population (N = 1.6M). Net costs (vaccination + medical) and QALYs increased by S$0.3 million and 2693, respectively, yielding a cost/QALY of S$105 for PCV20. PCV20 was dominant among high-risk adults aged 18 to 64 years and all adults 65 to 99 years; among at-risk adults aged 18 to 64 years, cost/QALY for PCV20 was S$2081. PCV20 remained cost saving or highly cost-effective in sensitivity analyses.

Conclusions

Cost-effectiveness analysis suggests use of PCV20—in lieu of current Singapore Ministry of Health recommendations for adult pneumococcal vaccination—would represent a cost-effective use of scarce healthcare resources.