OBJECTIVE: Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group. DESIGN: Markov model-based cost-effectiveness analysis. METHODS: The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia. RESULTS: In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario. CONCLUSIONS: One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.
OBJECTIVE:Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group. DESIGN: Markov model-based cost-effectiveness analysis. METHODS: The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia. RESULTS: In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIVpatients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario. CONCLUSIONS: One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.
Authors: Catherine A Lexau; Ruth Lynfield; Richard Danila; Tamara Pilishvili; Richard Facklam; Monica M Farley; Lee H Harrison; William Schaffner; Arthur Reingold; Nancy M Bennett; James Hadler; Paul R Cieslak; Cynthia G Whitney Journal: JAMA Date: 2005-10-26 Impact factor: 56.272
Authors: E Hak; D E Grobbee; E A M Sanders; T J M Verheij; M Bolkenbaas; S M Huijts; W C Gruber; S Tansey; A McDonough; B Thoma; S Patterson; A J van Alphen; M J M Bonten Journal: Neth J Med Date: 2008-10 Impact factor: 1.422
Authors: Eugene V Millar; James P Watt; Melinda A Bronsdon; Jean Dallas; Raymond Reid; Mathuram Santosham; Katherine L O'Brien Journal: Clin Infect Dis Date: 2008-10-15 Impact factor: 9.079
Authors: Kenneth J Smith; Richard K Zimmerman; Chyongchiou J Lin; Mary Patricia Nowalk; Feng-Shou Ko; M Catherine McEllistrem; Mark S Roberts Journal: Vaccine Date: 2008-01-29 Impact factor: 3.641
Authors: Andrew J Leidner; Neil Murthy; Harrell W Chesson; Matthew Biggerstaff; Charles Stoecker; Aaron M Harris; Anna Acosta; Kathleen Dooling; Carolyn B Bridges Journal: Vaccine Date: 2018-12-04 Impact factor: 3.641
Authors: David W Hutton; Jeffrey S McCullough; Lisa Prosser; Wen Ye; William H Herman; Ping Zhang; Tamara Pilishvili; Jamison Pike Journal: Vaccine Date: 2021-01-23 Impact factor: 4.169
Authors: Philip Eng; Lean Huat Lim; Chian Min Loo; James Alvin Low; Carol Tan; Eng Kiat Tan; Sin Yew Wong; Sajita Setia Journal: Int J Gen Med Date: 2014-03-31