Table 3.
(a) Incremental cost and health outcomes in higher-valency pneumococcal vaccines. (b) ICERs and sensitivity analysis outcomes of higher-valency pneumococcal vaccines.
| (a) | ||||||||
| Country, Currency, Ref | Intervention | Age | Vaccine Cost | Medical Cost | Indirect Cost | Total Cost | QALY | LY |
| All risk * | ||||||||
| Denmark, 2022, EUR [57] | PCV20/PPV23 vs. PPV23 PCV20 vs. PPV23 |
≥18 high + ≥65 | 31,748,049 91,630,419 |
−57,782,573 −326,885,281 |
0 | −53,766,066 −396,115,884 |
1350 5821 |
1433 5821 |
| England, 2019, GBP [47] | PCV20 vs. PCV15/PPV23 PCV20 vs. PCV20/PPV23 PCV20 vs. PPV23 |
≥18 high + ≥65 | −177.3 −236.5 378.70 |
1.2 −171.4 −538.31 |
- - - |
−113.4 −235.3 −159,610,000 |
30,302 −343 91,375 |
- - - |
| Belgium, 2023, EUR [59] | PCV20 vs. PCV15/PPV23 PCV20 vs. No vaccination |
≥18 high +≥65 | −17,593,091 27,194,533 |
−9,314,716 −22,071,930 |
- - |
−26,907,807 5,122,603 |
0.00016 0.00038 |
0.00020 0.00038 |
| Spain, 2018, EUR [60] | PCV20 vs. PCV15/PPV23 | ≥60 | −21,200,000 | −64,600,000 | - | −85,700 | 5870 | 8907 |
| Italy, 2022, EUR [61] | PCV20 vs. PCV13 PCV20 vs. PCV15 |
65–74 | 40,568,000 40,568,000 |
−48,032,000 −40,205,000 |
- - |
−7,464,000 −364,000 |
4734.0 3984.7 |
6581.6 5536.7 |
| USA, 2017, USD [51] | PCV20 vs. No vaccination PCV15/PPV23 vs. No vaccination |
≥65 | - - |
- - |
- - |
151 83 |
0.00072 0.00011 |
- - |
| USA, 2021, EUR [54] | PCV20 vs. No vaccination x3 PPV23 vs. No vaccination PCV15 vs. No vaccination |
≥65 | 16,620,000 17,750,000 15,300,000 |
−7,420,000 −5,170,000 −4,310,000 |
−390,000 −220,000 −230,000 |
8,710,000 12,290,000 10,710,000 |
963 662 559 |
- - - |
| Greece, 2022, EUR [5] | PCV20 vs. PCV15/PPV23 PCV20 vs. PCV15 |
≥18 | - | - | - | −48,858 −11,183 |
1536 1594 |
1883 1962 |
| Immunocompetent | ||||||||
| Norway, 2022, EUR [56] | PCV20 vs. PPV23 | ≥18 | 67,200,826 | −140,808,171 | - | −73,607,345 | 7966 | 7584 |
| Belgium, 2023, EUR [59] | PCV20 vs. No vaccination | 65–84 | 10,461,746 | −12,204,474 | - | −1,742,727 | 0.0007 | 0.0008 |
| USA, 2017, USD [48] | PCV20 vs. PPV23 PCV20/PPV23 vs. PPV23 |
≥65 | - - |
60.08 82.67 |
0.00035 0.00003 |
- - |
||
| Italy, 2013, EUR [55] | PCV15/PPV23 vs. PCV13/PPV23 PCV15/PPV23 vs. PCV20/PPV23 PCV15/PPV23 vs. PCV20 PCV15/PPV23 vs. No vaccination |
50–100 | 0 0 53,184,529 185,043,395 |
- | - | −11,630,171 58,642,975 92,033,528 56,669,841 |
1488 −7559 −5255 15,718 |
4414 −22,401 −14,493 44,783 |
| Immunocompromised | ||||||||
| Italy, 2013, EUR [55] | PCV15/PPV23 vs. PCV13/PPV23 | ≥18 | 0 | - | - | −19,967,763 | 2778 | 9279 |
| (b) | ||||||||
| Country, Currency, Ref | Intervention | Age | ICERs | The Most Impactful Parameter in DSA | PSA | Conclusion | ||
| % CE | WTP | Scatter Plot Distribution | ||||||
| All risk * | ||||||||
| Denmark, 2022, EUR [57] | PPV23/PCV20 vs. PPV23 PCV20 vs. PPV23 |
≥18 | −44,326 −68,054 |
Time horizon | - - |
- - |
100% SE 100% SE |
PCV20 was a dominant strategy in both cases |
| England, 2019, GBP [47] | PCV20 vs. PCV15/PPV23 PCV20 vs. PCV20/ PPV23 PCV20 vs. PPV23 |
≥18 high + ≥65 | Dominant −686,948 Dominant |
Robust | - - 85% 99% |
- - 20,000 30,000 |
- - Majority SE Majority NE |
PCV20 was cost-saving compared to PPV23 in adults aged 65–99 years and adults aged 18–64 years with underlying conditions |
| Belgium, 2023, EUR [59] | PCV20 vs. PCV15 / PPV23 PCV20 vs. No vaccination |
≥18 high + ≥65 | Dominant 4164 |
Cost and incidence of inpatients all-cause NBP, VE | 100% 100% |
35,000 | 100% SE 87% NE, 13% SE |
PCV20 was cost-effective compared to no vaccination and cost-saving compared to PCV15/PPV23 |
| Spain, 2018, EUR [60] | PCV20 vs. PCV15/PPV23 | ≥60 | −14,605 | Robust | 100% | 25,000 | 100% SE | PCV20 was more cost-effective than PCV15/PPV23 |
| Italy, 2022, EUR [61] | PCV20 vs. PCV13 PCV20 vs. PCV15 |
65–74 | Dominant 91 |
Robust | 90% 90% |
5000 5000 |
- | PCV20 was dominant over PCV13 and more cost-effective than PCV15 |
| USA, 2017, USD [51] | PCV20 vs. No vaccination PCV15/PPV23 vs. No vaccination |
≥65 | 210,529 728,423 |
Robust | >50% 6% |
190,000 200,000 |
- | Within the WTP range, only PCV20 was favorable in non-Black people |
| USA, 2021, EUR [54] | PCV20 vs. No vaccination x3 PPV23 vs. No vaccination PCV15 vs. No vaccination |
≥65 | 9051 18,559 19,162 |
Vaccine price, the VE, vaccine waning rate, the proportion of pCAP | 90% - - |
20,000 | - | PCV20 was reported to be the cost-effective strategy if PCV10 was continued in children |
| Greece, 2022, EUR [5] | PCV20 vs. PCV15/PPV23 PCV20 vs. PCV15 |
≥18 | Dominant Dominant |
Robust | 100% 100% |
34,000 | - | PCV20 was a dominant vaccination strategy over PCV15 alone or followed by PPV23 |
| Immunocompetent | ||||||||
| Norway, 2022, EUR [56] | PCV20 vs. PPV23 | ≥18 | −9420 | Inpatient cost of NBPP, PCV20 vaccine price, PCV20 VE in NBPP | - | - | 100% SE | PCV20 was cost-effective compared to PPV23 |
| Belgium, 2023, EUR [59] | PCV20 vs. No vaccination | 65–84 | Dominant | Robust | - | 35,000 | 77% SE, 23% NE | PCV20 was cost-saving in 65–84-year-old adults with a chronic underlying condition |
| USA, 2017, USD [48] | PCV20 vs. PPV23 PCV20/PPV23 vs. PPV23 |
≥65 | 172,491 3,115,054 |
Vaccine cost, VE, PP risk in high-risk adults | 16–34% | 100,000–150,000 | - | PCV20 and PCV20/PPV23 were not more favorable economically than PPV23 |
| Italy, 2013, EUR [55] | PCV15/PPV23 vs. PCV13/PPV23 PCV15/PPV23 vs. PCV20/PPV23 PCV15/PPV23 vs. PCV20 PCV15 /PPV23 vs. No vaccination |
50–100 | Dominant Dominated Dominated 3605 |
Probability of AMR for NBPP, age-specific utility, serotype-specific vaccine efficacy in NBPP | 0% Dominated Dominated 0% |
40,000 | SE 100% NW 100% NW 100% NE |
Sequential vaccination with either PCV15 or PCV20 combined with PPSV23 led to better health outcomes than PCV13/PPV23 and no vaccination |
| Immunocompromised | ||||||||
| Italy, 2013, EUR [55] | PCV15/PPV23 vs. PCV13/PPV23 | ≥18 | Dominant | Probability of AMR for NBPP, age-specific utility, serotype-specific vaccine efficacy in NBPP | Regardless | 100% | 100% SE | PCV15/ PPSV23 was cost-saving compared to PCV13/PPV23 |
Abbreviation: QALY: quality-adjusted life-year; LY: life-years; PCV13/PPV23: PCV13 followed by PPV23; PCV15/PPV23: PCV15 followed by PPV23; PCV20/PPV23: PCV20 followed by PPV23; x3 PPV23: three doses of PPV23. All risk *: including immunocompetent and immunocompromised groups. PCV13/PPV23: PCV13 followed by PPV23; PCV15/PPV23: PCV15 followed by PPV23; PCV20/PPV23: PCV20 followed by PPV23; x3 PPV23: three doses of PPV23; NBPP: non-bacteremic pneumococcal pneumonia; NBP: non-bacteremic pneumonia; pCAP: pneumococcal community-acquired-pneumonia VT: vaccine type; VE: vaccine effectiveness, AMR: antibiotic resistance, SE: South East, NE: North East, NW: North West; ICERs: incremental cost-effectiveness ratio; DSA: deterministic sensitivity analysis; PSA: probabilistic sensitivity analysis; WTP: willingness to pay. All risk *: including immunocompetent and immunocompromised groups.