Pneumococcal vaccination in the prevention of community-acquired pneumonia: an optimistic view of cost-effectiveness.

Recent studies have shown that there are approximately 40,000 to 45,000 cases of invasive pneumococcal disease and 480,000 to 800,000 hospital discharges for pneumococcal pneumonia (all-listed diagnoses) in the United States each year. The impact of pneumococcal disease is especially severe among older persons > or = 65 years in age. Case-control studies and indirect cohort studies have shown that pneumococcal vaccination is effective in preventing invasive pneumococcal disease in older, high-risk patients. The Office of Technology Assessment has shown that pneumococcal vaccination would be cost-effective in preventing pneumococcal pneumonia in the elderly. However, in the absence of data on the clinical effectiveness of vaccination in preventing pneumococcal pneumonia, physicians have been reluctant to vaccinate their patients, and only 20% of older persons have ever been immunized. Yet it is not necessary to know whether the vaccine is clinically effective or cost-effective in preventing pneumococcal pneumonia in order to know how to manage patients. Because pneumococcal vaccine prevents invasive pneumococcal disease, it is indicated for all older, high-risk patients.