PCV21 Shows Cost Effectiveness Compared With PCV15, PCV13, and PPSV23

The use of 21-valent pneumococcal conjugate vaccine (PCV21) for adults aged 19 to 64 years with underlying conditions can be cost effective or cost saving in most cases, according to results of a study published in the American Journal of Preventive Medicine. Currently, the CDC recommends pneumococcal vaccination for children younger than 5 years and adults 50 years and older. In certain cases, children aged 2 through 18 years and adults younger than 50 years may receive a pneumococcal vaccination based on risk-based indications for the vaccine.^1,2

“Assuming an average time since last vaccination of 2 years and 5 years for PCV15 and PPSV23 [pneumococcal polysaccharide vaccine 23] and/or PCV13, respectively, the results indicated that PCV21 significantly improved health outcomes, reducing PD [pneumococcal disease] cases and deaths compared [with] the recommended options (PPSV23, PCV15, and PCV20) for the vaccine-experienced at-risk (AR) and high-risk (HR) adults aged 19-64 years,” the study authors wrote.¹

Previously, pneumococcal vaccination was recommended for adults 65 years and older; however, in 2022, the Advisory Committee on Immunization Practices revised the recommendation to include patients 50 years and older. Along with the updated age recommendation, 2 new vaccines were also recommended, PCV15 and PCV20, and PCV13 was removed. In data from another study published in the American Journal of Preventive Medicine, investigators found that 13.2% of adults received a pneumococcal vaccine, with 9.6% receiving PCV20. Uptake was also higher for patients 65 years and older, at 23.8%, than for patients aged 60 to 64 years, at 12.1%. Additionally, the lowest uptake was in patients aged 19 to 49 years, at 4.7%.³

Investigators in the current study aimed to evaluate health and economic outcomes in vaccine-experienced patients aged 19 to 64 years with underlying medical conditions who received PCV21 compared with PCV20, PCV15, and PPSV23. They analyzed the total lifetime clinical outcomes, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Investigators also divided the cohort into 2 groups––patients aged 19 to 49 years and those aged 50 to 64 years––as the input profiles were substantially different.¹

The results showed that PCV21 improved all outcomes for patients aged 19 to 64 years, including invasive pneumococcal disease, postmeningitis sequelae, nonbacteremic pneumococcal pneumonia, and death rates, compared with the recommended options—PCV20, PCV15, and PPSV23. For this age range, the ICERs were $99,707 per quality-adjusted life year (QALY) gained for PCV21 compared with PPSV23 for patients who had previously received PCV13, and $140,230 per QALY gained compared with PPSV21 for those who had previously received PCV15. As for cost savings, investigators found approximately $5838 per QALY gained for PCV21 compared with PCV15 for those who had received PPSV23. For PCV20, cost savings were associated with PCV21.¹

For patients aged 50 to 64 years, PCV21 also showed improvements across all health outcomes compared with the other 3 vaccines. The ICERs were $62,410 and $85,412 per QALY gained compared with those who previously received PPSV23 and PCV15 and PCV15, respectively. The cost savings for this age range were $49,305 per QALY gained compared with PCV15 for those who received PPSV23. Similarly, PCV21 showed cost savings compared with PCV20.¹

“The analyses indicated favorable ICERs for PCV21 across all vaccine-experienced populations, ranging from cost saving to $149,200 per QALY gained,” the study authors wrote.¹ “The thorough sensitivity analysis reinforced the robustness of these findings. Additionally, the scenario analysis assuming a longer time since last vaccination of 8 years showed similar cost-effectiveness.”

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Yi Z, Elbasha EH, Owusu-Edusei K. What about vaccine-experienced younger adults? cost-effectiveness of PCV21 use in vaccine-experienced US adults aged 19-64 years with underlying medical conditions. Am J Prev Med. Published online October 17, 2025. doi:10.1016/j.amepre.2025.108159

2. Pneumococcal vaccine recommendations. CDC. October 26, 2024. Accessed October 23, 2025. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html

3. Averin A, Vietri J, Mohs AA, Willis SJ, Lonshteyn A, Weycker D. Uptake of pneumococcal vaccines among US adults after 2022 update to recommendations. AJPM Focus. 2025;4(5):100384. doi:10.1016/j.focus.2025.100384