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Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions

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Abstract

Background

Previous systematic reviews concluded that pneumococcal vaccination in the elderly was cost effective. However, recently published economic evaluations state that it may not be cost effective when children are vaccinated with higher-valent pneumococcal conjugate vaccines. The literature suggests that the outcomes of vaccination in the elderly are strongly influenced by the vaccine effectiveness (VE) against the vaccine-type pneumococcal diseases (PD) and the impact of childhood vaccination on the vaccine-type PD incidence in the elderly, but the extent remains unclear.

Methods

We conducted a systematic literature search of cost-effectiveness studies on vaccination in the elderly in the PubMed database starting from 2006. We included studies that consider the presence of a childhood vaccination with pneumococcal conjugate vaccine (PCV) 10 and PCV13. We focus on methods and assumptions used in modeling VE and epidemiology of PD over time.

Results

Twenty-eight economic evaluations underwent full-text review and data extraction. Thirteen were selected for quality assessment. The studies with a higher quality score provide evidence that vaccinating the elderly with PCV13 is not cost effective, when an ongoing rapid decline in the incidence of PCV13-type PD is modeled. A moderate persistence of PCV13 serotypes, in particular due to PCV10 childhood vaccination, makes vaccination of the elderly with PCV13 more attractive. There is no agreement that combining PCV13 with polysaccharide vaccine PPSV23 is cost effective. PPSV23 is attractive when it is effective against non-invasive PD.

Conclusion

Methodological approaches and assumptions in modeling VE and the indirect effects of childhood vaccination have a major impact on outcomes of decision-analytic models and cost-effectiveness estimates. Considering recently observed trends in the epidemiology of pneumococcal serotypes, there is currently inconclusive evidence regarding the cost effectiveness of pneumococcal vaccination of the elderly due to lack of studies that model key serotypes such as serotype 3 separately from other groups of serotypes.

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Acknowledgements

Alexander Kuhlmann and Marina Treskova developed the study design the search strategy and Marina Treskova conducted the literature search. Marina Treskova and Stefan M. Scholz screened, included, and excluded the studies and extracted the data for the following analyses and conducted quality assessment with the quality scoring via EVIDEM. Alexander Kuhlmann was consulted in any case of missing consensus. Alexander Kuhlmann conducted calculations of the expected vaccine protection over time. Marina Treskova summarized the results and drafted the paper. Alexander Kuhlmann and Stefan M. Scholz participated in drafting, proof-reading, and editing the manuscript. All three authors contributed to the preparation of the figures, tables and supplemental files.

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Authors and Affiliations

  1. Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany

    Marina Treskova, Stefan M. Scholz & Alexander Kuhlmann

  2. Department of Health Economics and Health Management, School of Public Health, Bielefeld University, Bielefeld, Germany

    Stefan M. Scholz

  3. Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany

    Alexander Kuhlmann

Authors
  1. Marina Treskova
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  2. Stefan M. Scholz
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  3. Alexander Kuhlmann
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Correspondence to Marina Treskova.

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Data availability statement

The data used in the present review can be found in the studies cited in the main and supplemental text. All other data generated during the review are available from the corresponding author upon request.

Funding

This study was funded by the Center for Health Economics Research Hannover (CHERH) of Gottfried Wilhelm Leibniz Universität Hannover, Hannover, Germany.

Conflict of interest

Marina Treskova, Stefan M. Scholz, and Alexander Kuhlmann declare that they have no conflict of interest.

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Treskova, M., Scholz, S.M. & Kuhlmann, A. Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions. PharmacoEconomics 37, 1093–1127 (2019). https://doi.org/10.1007/s40273-019-00805-5

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