Ismael R. Ortega-Sanchez, National Immunization Program, ESD, OD, Center for Disease Control, 1600 Corporate Square Boulevard, M/S E-61, Atlanta, GA, USA and Ben Schwartz, NIP, ESD, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA, USA.
KEYWORD1:
elderly revaccination, pneumococcal polysaccharide vaccine, cost-effectiveness, protective efficacy
BACKGROUND:
Effectiveness of pneumococcal polysaccharide vaccine (PPV) in elderly people has been found to decrease substantially with age and time. Arguments in favor of revaccination have been made. However, insufficient evidence regarding both the duration of PPV protection and the effectiveness of a second dose, introduce a lot of uncertainty to the detriment of the revaccination option.
OBJECTIVE:
To evaluate the projected health and economic impacts of revaccinating healthy elderly people with PPV in the context of sizable vaccine efficacy uncertainty in revaccinees.
METHOD:
A semi-Markov decision model with conditional protective efficacy probabilities is utilized for the cost-effectiveness analysis of revaccinating elderly people with PPV. In the model, we introduced projected age-dependent levels for a second dose efficacy for a hypothetical US elderly population. We considered a hypothetical 10-year routine vaccination intervention and incrementally compared with current one-dose vaccination policy. We included indirect and direct costs of the disease and vaccination program and conducted a Monte Carlo simulation analysis. Results are measured in cost per number of life years saved and cost per episode of meningitis, bacteremia and bacteremic pneumonia prevented
RESULT:
It is expected that revaccination of elderly will prevent a considerable number of meningitis, bacteremia and bacteremic pneumonia episodes. It is also expected that for high levels of protective efficacy the revaccination interventions will be cost saving. However, for low levels of protective efficacy revaccinating may not be cost saving from both societal and health care payer perspectives. Even in those situations the intervention is expected to be cost-effective. Likewise, levels of protective efficacy would condition the cost-effectiveness of the intervention
CONCLUSION:
This study intends to overcome important uncertainties of revaccinating elderly people with PPV and provide the basis for potential policy recommendations.
LEARNINGOBJECTIVES:
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