Results of a cohort model analysis of the cost-effectiveness of routine immunization with 13-valent pneumococcal conjugate vaccine of those aged ≥65 years in the Netherlands

Background: Community-acquired pneumonia and invasive pneumococcal disease are common among older people (ie, those aged ≥65 years). A new 13-valent pneumococcal conjugate vaccine (PCV-13) is under study in the Netherlands.Objective: The aim of this work was to model the cost-effectiveness of PCV-13 vaccination among those aged ≥65 years in the Netherlands, both in the total population and in those at increased risk for pneumonia, for various levels of efficacy (30%–90%) assumed.Methods: Our previously published cost-effectiveness model was updated to include age-specific epidemio-logic data and health-care utilization and costs for a hypothetical cohort of adults aged ≥65 years in the Netherlands. This cohort was followed twice—once as unvaccinated and once as vaccinated—over a time period of 5 years, with differences between both analyses reported. Outcome measures included costs, life-years gained (LYGs), quality-adjusted life-years, and incremental cost-effectiveness ratios (ICERs). All analyses were performed from a societal perspective.Results: In the model, the ICER for vaccination remained below €80,000/LYG, except when the vaccine was assumed to protect only against bacteremic pneumonia, with a relatively low effectiveness (40%) in combination with a high vaccine price (€65), and indirect effects of serotype replacement would largely offset the direct effect of vaccination. For various assumptions, introduction of widespread PCV-13 vaccination (assuming a 60% efficacy against invasive and noninvasive disease because of vaccine serotypes, and a cost of €50 per vaccinated person) was associated with the ICERs varying from cost-saving to €50,676/LYG.Conclusions: In this model analysis of a hypothetical cohort in the Netherlands, vaccination with PCV-13 might be considered cost-effective, both for the total population and for the high-risk population aged ≥65 years, from a societal perspective, over a 5-year time horizon. The main limitation of this study was uncertainty regarding how great a proportion of pneumonia could be attributed to pneumococcal disease.