Table 2.
(a) Incremental cost and health outcomes in lower-valency pneumococcal vaccines. (b) ICERs and sensitivity analysis outcomes of lower-valency pneumococcal vaccines.
| (a) | |||||||||
| Country, Currency, Ref | Intervention | Age | Vaccine Cost | Medical Cost | Indirect Cost | Total Cost | QALY | LY | |
| All risk * | |||||||||
| Japan, 2021, JPY [41] | PCV13 vs. No vaccination PPV23 vs. No vaccination PCV13 vs. PPV23 |
60–64 | 10,230 7736 2494 |
−1598 −853.05 −745.40 |
1642 1699 −57.28 |
10,274 8582 1691 |
0.0076 0.0041 0.0035 |
0.0087 0.0047 0.0040 |
|
| Portugal, 2014, EUR [62] | PCV13 vs. No vaccination PCV13 vs. PPV23 |
≥65 | - | - | - | 46.65 33.11 |
0.003 0.003 |
0.004 0.004 |
|
| Sweden, 2020, EUR [44] | PPV23 vs. No vaccination | ≥65 ≥75 |
3,297,459 2,252,084 |
−893,859 −1,041,454 |
- - |
2,526,940 1,333,970 |
27 45 |
- - |
|
| Norway, 2022, EUR [58] | PPV23 vs. No vaccination | ≥65 ≥75 |
3,085,982 1,771,496 |
−1,949,287 −1,883,861 |
1,263,986 14,927 |
15.91 15.48 |
- - |
||
| Netherlands, 2018, EUR [52] | PPV23 vs. No vaccination | 60 65 70 |
- - - |
- - - |
- - - |
13,144,010 9,845,099 6,403,943 |
909 1031 1033 |
- - - |
|
| PCV13 vs. No vaccination | 60 65 70 |
- - - |
- - - |
- - - |
60,792,248 54,040,383 41,029,247 |
910 1227 1161 |
- - - |
||
| South Korea, 2016, USD [45] | PCV13 vs. PPV23 PCV13/PPV23 vs. PPV23 |
≥65 | - - |
- - |
- - |
- - |
- - |
- - |
|
| Canada, 2014, CAN [49] | PCV13/PPV23 vs. PPV23 | ≥65 | 254,300,000 | −135,600,000 | - | 118,700,000 | 0.0006 | 1,100,000 | |
| Argentina, 2020, USD [50] | PCV13/PPV23 vs. PPV23 | ≥65 | - | - | - | 21,667,742 | - | 716.44 | |
| Immunocompetent | |||||||||
| Thailand, 2021, USD [42] | PCV13 vs. No vaccination PPV23 vs. No vaccination |
≥65 | - - |
- - |
- - |
5.67 18.27 |
0.02 0.01 |
0.06 0.02 |
|
| China, 2013, USD [43] | PPV23 vs. No vaccination | ≥60 | - | - | - | 1,962,000 | 10,321 | - | |
| USA, 2014, USD [46] | PPV23 vs. No vaccination PCV13/PPV23, program vs. No vaccination |
≥65 | - - |
- - |
- - |
67.45 67.87 |
0.00030 0.00009 |
- - |
|
| USA, 2019, USD [53] | PCV13/PPV23 vs. PPV23 | 50–64 | - | - | - | −0.32 | 0.00043 | - | |
| PCV13/PPV23 | All vs. Chronic | - | - | - | 39.16 | 0.00068 | - | ||
| Immunocompromised | |||||||||
| Thailand, 2021, USD [42] | PCV13 vs. No vaccination PPV23 vs. No vaccination |
≥65 | - - |
- - |
- - |
12.31 30.98 |
0.02 0.23 |
0.73 0.68 |
|
| South Korea, 2016, USD [45] | PCV13 vs. PPV23 PCV13/PPV23 vs. PPV23 |
≥65 | - - |
- - |
- - |
- - |
- - |
- - |
|
| Canada, 2014, CAN [49] | PCV13/PPV23 vs. PPV23 | ≥65 | 149,800,000 | −120,300,000 | - | 29,500,000 | 0.0009 | 1,600,000 | |
| (b) | |||||||||
| Country, Currency, Ref | Intervention | Age | ICERs | The Most Impactful Parameter in DSA | PSA | Conclusion | |||
| % CE | WTP | Scatter Plot Distribution | |||||||
| All risk * | |||||||||
| Japan, 2021, JPY [41] | PCV13 vs. No vaccination PPV23 vs. No vaccination PCV13 vs. PPV23 |
60–64 | 1,356,218 2,103,602 483,867 |
VE in NBP, discounting | 98.0% 87.7% 89.3% |
5,000,000 | 100% NE 99% NE 100% NE |
PCV13 was more cost-effective than PPV23 or no vaccination | |
| Portugal, 2014, EUR [62] | PCV13 vs. No vaccination PCV13 vs. PPV23 |
≥18 | 17,746 13,146 |
PCV13 effectiveness | 94% 94% |
20,000 | - - |
PCV13 was more cost-effective than PPV23 or no vaccination | |
| Sweden, 2020, EUR [44] | PPV23 vs. No vaccination | ≥65 ≥75 |
93,578 29,468 |
Vaccine effectiveness, VT pneumococcal disease | - | 50,000 | - | PPV23 can be cost-effective at 75 years but not 65 years | |
| Norway, 2022, EUR [58] | PPV23 vs. No vaccination | ≥65 ≥75 |
79,451 964 |
Vaccination coverage | - | 28,004–84,011 | - | PPV23 was cost-effective in the 65- and 75-year-old cohorts | |
| Netherlands, 2018, EUR [52] | PPV23 vs. No vaccination | 60 65 70 |
14,452 9553 6201 |
Mortality rate, total cost of program implementation | - | 20,000 | - | PPV23 was the most cost-effective strategy in the projection of using PCV10 in infants | |
| PCV13 vs. No vaccination | 60 65 70 |
66,796 44,028 35,346 |
- | - | |||||
| South Korea, 2016, USD [45] | PCV13 vs. PPV23 PCV13/PPV23 vs. PPV23 |
≥65 | 1421 3300 |
Vaccine effectiveness of PCV13 against NBPP, incidence of NBPP | - | GDP: 27,633 | 100% NE | PCV13/PPV23 was more cost-effective than PPV23 regardless of co-morbidity | |
| Canada, 2014, CAN [49] | PCV13/PPV23 vs. PPV23 | ≥65 | 35,484 | ACP hospitalization cost, PCV13-VE against VT- NBPP |
100% | 50,000 | 49% NE | PCV13/PPV23 was more cost-effective than PPV23 | |
| Argentina, 2020, USD [50] | PCV13/PPV23 vs. PPV23 | ≥65 | Dominant ** | Percentage of adjustment for PP rate by urine analysis, at-risk pneumonia inpatient cost, pneumonia incidence | - | - | 98% SE | PCV13/PPV23 was a cost-saving option | |
| Immunocompetent | |||||||||
| Thailand, 2021, USD [42] | PCV13 vs. No vaccination PPV23 vs. No vaccination PCV13 vs. PPV23 |
≥65 | 233.63 1439.25 - |
Fatality of NBPP, PCV13 pneumonia efficacy | - - 80% |
5003 | - Majority NE 80% NE |
PCV13 dominated over PPV23 | |
| China, 2013, USD [43] | PPV23 vs. No vaccination | ≥60 | 190.1 | VT-effectiveness against CAP, epidemiological data for CAP, administrative costs for PPV23 | - | GDP: 14,759 | - | PPV23 was cost-effective | |
| USA, 2014, USD [46] | PPV23 vs. No vaccination PCV13/PPV23, program vs. No vaccination |
≥65 | 226,733 765,018 |
Robust | 30% 5% |
200,000 | - | PPV23 was more cost-effective than PCV13/PP23 | |
| USA, 2015, USD [53] | PCV13/PPV23 vs. PPV23 | 50–64 | Dominant | PCV13 vaccine price | 60.3% 14.8% |
50,000 100,000 |
- | PCV13/PPSV23 was more cost-effective than PPV23, being the least costly in ≥50-year-old people with chronic conditions | |
| PCV13/PPV23 | All vs. chronic | 57,786 | PCV13 vaccine price | 37% 82.9% |
50,000 100,000 |
- | |||
| Immunocompromised | |||||||||
| Thailand, 2021, USD [42] | PCV13 vs. No vaccination PPV23 vs. No vaccination PCV13 vs. PPV23 |
≥65 | 627.24 136.13 - |
Utility in the elderly, VT-efficacy against pneumonia | - 70% at 250 90% at 4000 |
5003 | - 100% NE Majority NE |
PCV13 was more cost-effective than PPV23 | |
| South Korea, 2016, USD [45] | PCV13 vs. PPV23 PCV13/PPV23 vs. PPV23 |
≥65 | 1736 3404 |
PCV13 VE against VT-NBPP Incidence of NBPP |
- | GDP: 27,633 | 100% NE | PCV13/PPV23 was more cost-effective than PPV23 regardless of co-morbidity | |
| Canada, 2014, CAN [49] | PCV13/PPV23 vs. PPV23 | ≥65 | 10,728 | PCV13 VE against vaccine-type NBPP | 100% | 50,000 | 82% NE | PCV13/PPV23 is incredibly cost-effective in high-risk adults | |
Abbreviation: QALY: quality-adjusted life-year; LY: life-years; PCV13/PPV23, program: PCV13 followed by PPV23 plus expand vaccine uptake; PCV13/PPV23: PCV13 followed by PPV23. All risk *: including immunocompetent and immunocompromised groups. PCV13/PPV23, program: PCV13 followed by PPV23 plus expanded vaccine uptake; PCV13/PPV23: PCV13 followed by PPV23; NBPP: non-bacteremic pneumococcal pneumonia; NBP: non-bacteremic pneumonia; PP: pneumococcal pneumonia ACP: all-cause pneumonia; CAP: community-acquired-pneumonia VT: vaccine type; VE: vaccine effectiveness; SE: South East, NE: North East, DSA: deterministic sensitivity analysis; PSA: probabilistic sensitivity analysis; ICERs: incremental cost-effectiveness ratio; WTP: willingness to pay. All risk *: including immunocompetent and immunocompromised groups. Dominant **: The unit of ICER is the cost per life-year.