• Kenneth J Smith, Angela R Wateska, Mary Patricia Nowalk, Mahlon Raymund, Bruce Y Lee, and Richard K Zimmerman.
• Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: smitkj2@UPMC.EDU.
• Am J Prev Med. 2013 Apr 1; 44 (4): 373381373-381.

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) is approved by the U.S. Food and Drug Administration for adults, but its role in older adults is unclear.PurposeTo compare PCV13 strategies to currently recommended vaccination strategies in adults aged ≥65 years.MethodsUsing a Markov model, the cost effectiveness of PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), alone or in combination, was estimated, in adults aged either 65 years or 75 years. No prior vaccination, prior vaccination, and vaccine hyporesponsiveness scenarios were examined. Pneumococcal disease rates, indirect childhood PCV13 effects, and costs were estimated using CDC Active Bacterial Core surveillance data and U.S. national databases. An expert panel estimated vaccine-related protection. A societal perspective was taken and outcomes were discounted 3% per year.ResultsIn those aged 65 years, single-dose PCV13 cost $11,300 per quality-adjusted life-year (QALY) gained compared to no vaccination; at ages 65 and 80 years, PCV13 cost $83,000/QALY. In those aged 75 years, single-dose PCV13 cost $62,800/QALY gained. PPSV23 cost more and was less effective than PCV13. Results were sensitive to varying vaccine effectiveness and indirect effect estimates. In hyporesponsiveness scenarios, cost-effectiveness ratios increased by 37%-78% for single-dose strategies and 29%-35% for multiple-dose strategies.ConclusionsSingle-dose PCV13 strategies are likely to be economically reasonable in older adults.Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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