Cost-Effectiveness of Pneumococcal Vaccination and Uptake Improvement Programs in Underserved and General Population Adults Aged < 65 Years

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In US adults aged < 65 years, pneumococcal vaccination is recommended when high-risk conditions are present, but vaccine uptake is low. Additionally, there are race-based differences in illness risk and vaccination rates. The cost-effectiveness of programs to improve vaccine uptake or of alternative vaccination policies to increase protection is unclear. A decision analysis compared, in US black and general population cohorts aged 50 years, the public health impact and cost-effectiveness of pneumococcal vaccination recommendations, without and with a vaccine uptake improvement program, and alternative population vaccine policies. Program-based uptake improvement (base case: 12.3% absolute increase, costing $1.78/eligible patient) was based on clinical trial data. US data informed population-specific pneumococcal risk. Vaccine effectiveness was estimated using Delphi panel and trial data. In both black and general population cohorts, an uptake improvement program for current vaccination recommendations was favored, costing $48,621 per QALY gained in black populations ($54,929/QALY in the general population) compared to current recommendations without a program. Alternative vaccination policies largely prevented less illness and were economically unfavorable. In sensitivity analyses, uptake programs were favored, at a $100,000/QALY threshold, unless they improved absolute vaccine uptake < 2.1% in blacks or < 2.6% in the general population. Results were robust in sensitivity analyses. Programs to increase adult pneumococcal vaccination uptake are economically reasonable compared to changes in vaccination recommendations, and more favorable in underserved minorities than in the general population. If addressing race-based health disparities is a priority, evidence-based programs to increase vaccination should be considered.

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This work was supported by the National Institutes of Health (Grant No. R01 AI11657503), who had no role in the study design, data analysis, or decision to publish.


This work was supported by the National Institutes of Health (Grant No. R01 AI11657503).

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Correspondence to Kenneth J. Smith.

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Conflict of interest

Dr. Zimmerman has no current conflicts of interest but within 3 years had research grants from Sanofi Pasteur, Merck & Co., and Pfizer on unrelated topics. Drs. Nowalk and Lin have an active research grant from Merck & Co. on an unrelated topic, and had research grants within 3 years from Pfizer and Sanofi Pasteur on unrelated topics that are no longer active. Dr. Schaffner is a member of data safety monitoring boards for Merck and Pfizer, and has served as a consultant for Dynavax, Novavax, GSK, Sanofi-Pasteur and Seqirus. Dr. Harrison is on a scientific advisory board for GSK. Other authors have no competing interests to disclose.

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Wateska, A.R., Nowalk, M.P., Lin, C.J. et al. Cost-Effectiveness of Pneumococcal Vaccination and Uptake Improvement Programs in Underserved and General Population Adults Aged < 65 Years. J Community Health 45, 111–120 (2020) doi:10.1007/s10900-019-00716-8

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  • Pneumococcal vaccination
  • Cost-effectiveness analysis
  • Underserved