Cost‐Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations
| Autor: | Richard K. Zimmerman, Lee H. Harrison, Chyongchiou J. Lin, William Schaffner, Mary Patricia Nowalk, Angela R. Wateska, Kenneth J. Smith |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Cost effectiveness Cost-Benefit Analysis Population Psychological intervention Black People 01 natural sciences Article Pneumococcal conjugate vaccine Pneumococcal Vaccines 03 medical and health sciences 0302 clinical medicine Environmental health medicine Humans 030212 general & internal medicine 0101 mathematics education Aged education.field_of_study Models Statistical Immunization Programs business.industry Health Policy Vaccination 010102 general mathematics Cost-effectiveness analysis Pneumonia Pneumococcal Pneumococcal polysaccharide vaccine Pneumococcal vaccine Female Quality-Adjusted Life Years Geriatrics and Gerontology business medicine.drug |
| Zdroj: | J Am Geriatr Soc |
| ISSN: | 1532-5415 0002-8614 |
| Popis: | Background/objectives Recently revised vaccination recommendations for US adults, aged 65 years and older, include both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost-effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear. Design Markov decision analysis. Setting and participants Hypothetical 65-year-old general and black population cohorts. Intervention Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs. Results The current pneumococcal vaccination recommendation was the most effective strategy, but afforded slight public health benefits compared to an alternative (PPSV23 for all older people plus PCV13 for the immunocompromised) and cost greater than $750 000 per quality-adjusted life-year (QALY) gained in either population group with a vaccine uptake improvement program (absolute uptake increase = 12.3%; cost = $1.78/eligible patient) in place. The alternative strategy was more economically favorable, but cost greater than $100 000/QALY in either population, with or without an uptake intervention. Results were robust in sensitivity analyses; however, in black older people, the alternative strategy with an uptake program was most likely to be favored in probabilistic sensitivity analyses at a $150 000/QALY gained threshold. Conclusion Current pneumococcal vaccination recommendations for US older people are economically unfavorable compared to an alternative strategy omitting PCV13 in the immunocompetent. The alternative recommendation with an uptake improvement program may be economically reasonable in black population analyses and could be worth considering as a population-wide recommendation if mitigating racial disparities is a priority. J Am Geriatr Soc 68:1271-1278, 2020. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text