Economic evaluations of pneumococcal vaccination strategies in adults. A summary of the results.

With the view to re-evaluate the current evidence about the efficiency of adult pneumococcal vaccination, we searched the Medline database to collect recent full economic evaluations on this topic. We included a literature review based on studies published up to June 2001 and 5 other studies published between July 2001 and April 2004. Based on these articles' results, pneumococcal vaccination of the elderly aged between 65 and 75 years is found to be relatively cost-effective for the health care payer. There is also evidence that vaccination of HIV+ patients and of young military personnel may be justifiable on the basis of economic evaluation including direct medical costs only. Conclusions about universal vaccination of younger adults (< 65 years) and of high-risk groups could not be drawn because of controversial results. An accurate assessment of the efficiency of adult pneumococcal vaccination is however hard to achieve given the difficulties in collecting valid input data (e.g. for the incidence and mortality of the disease) and given the remaining uncertainties about the vaccine efficacy for non-invasive disease. Finally, by lack of data, none of the studies estimated the impact of vaccination on antimicrobial resistance.