PCV24 Is Clinically, Economically Unfavorable Compared with PCV21
Researchers estimate the cost-effectiveness of PCV24 in the older adult population compared with the currently accepted pneumococcal vaccine schedules in the US.
The 24-valent pneumococcal conjugate vaccine (PCV24) was clinically and economically unfavorable for older adults when compared with currently recommended vaccine schedules in the US, including PCV20, PCV21, and PCV15 plus PPSV23. PCV21 was deemed most effective in protecting older adults against pneumococcal diseases, according to authors of a study published in the American Journal of Preventive Medicine.1
“The US adult pneumococcal vaccination recommendations have substantially changed recently, adding higher valency pneumococcal conjugate vaccines (PCVs) for use in older adults (ie, those aged ≥65 years) and in younger adults with conditions that confer higher pneumococcal disease risk,” wrote authors of the study. “In 2022, recommendations for 13-valent PCV (PCV13) use in these groups were superseded by recommendations for either PCV15 followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) or [PCV20 alone]. In addition, either PCV15 or PCV20 was also recommended for childhood use in 2023.”
As pneumococcal vaccination strategies are updated, researchers are simultaneously developing PCVs with higher valency. PCV7 was the first pneumococcal conjugate vaccine widely accepted, approved in the US in 2000.2 Since then, several formulations of the vaccine have been approved both for children and adults, with each requiring separate schedules to stay protected against pneumococcal diseases.
For the cost-effectiveness of pneumococcal vaccination in older adults, PCV21 “dominated” all other vaccine strategies. | image credit: aneduard / stock.adobe.com
READ MORE: People with HIV Show Significantly Low Pneumococcal Vaccination Rates
The most recent PCV approval for adults came in June 2024 when the FDA approved PCV21 (Capvaxive) in the US.3 Upon this approval, the FDA currently considers 4 different options for staying protected against pneumococcal diseases: PCV21, PCV20 (Prevnar20), PCV15 (Vaxneuvance), and PPSV23 (Pneumovax 23).2
“One of the newer conjugate vaccines, PCV24, was formulated on the basis of childhood pneumococcal disease serotypes epidemiology, as were prior PCV13, PCV15, PCV20, and PPSV23,” continued the authors.1 “PCV24 will increase covered serotypes in older adults (53%–63%) compared with PCV20 (45%–60%).”
Dynamic vaccination schedules continue to be developed for adults, children, and the elderly. With factors like herd immunity and indirect effects from pneumococcal vaccines taken into consideration, researchers explored PCV24 in the older adult population and compared their outcomes with other FDA-approved pneumococcal vaccines.
“This paper estimates the cost-effectiveness of PCV24 in older adults compared with that of currently recommended US pneumococcal vaccination strategies (PCV20, PCV21, or PCV15 plus PPSV23),” they wrote.1 “These analyses examine scenarios that consider differing childhood vaccination indirect effects and potential changes in disease-causing pneumococcal serotype distributions in older adults.”
To compare PCV24 with the currently accepted vaccine regimens, researchers identified patient characteristics, including age and race. Then, using CDC data, they determined study participants’ chronic medical condition–specific pneumococcal illness risks and serotype-specific disease risks.
The study’s Markov cohort model estimated pneumococcal disease cases and deaths and determined how these instances were associated with vaccination strategy. Researchers also presented the strategy-specific direct medical costs of PCV or PPSV as well as the costs of pneumococcal illness itself.
While PCV24 was found to prevent more disease cases and deaths than PCV20 and PCV15 plus PPSV23, researchers identified PCV21 as the most efficient and cost-effective option for the older adult population 65 years and older. Indeed, PCV21 substantially reduced pneumococcal disease events and decreased disparities in disease risk among Black and non-Black participants.
Finally, for the cost-effectiveness of pneumococcal vaccination in older adults, PCV21 “dominated” all other vaccine strategies.
“In-development PCVs may be economically unreasonable in older adults, regardless of serotype effectiveness assumptions, particularly when considering potential indirect effects from use of those vaccines in children,” according to authors of another study published in the American Journal of Preventive Medicine.4 “Adult vaccines containing higher-risk serotypes not contained in childhood vaccines may be more promising.”
When used in older adults, researchers confirmed that currently recommended and future childhood-formulated vaccines (PCV15, PCV20, or PCV24) were not as favorable as PCV21 in older adults. With the focus on this population, they determined that PCV21 was the most affordable and most successful in preventing pneumococcal diseases regardless of indirect vaccination effects.
“This analysis leads to the conclusion that currently recommended and future childhood-formulated vaccines are unlikely to be clinically or economically reasonable when used in older adults,” concluded the authors of the study.1 “PCV21, formulated on the basis of adult pneumococcal disease epidemiology, was more effective and cost effective than other vaccines and seems a logical choice that adds the benefits of greater serotype coverage for adults while avoiding problems related to indirect vaccination effects that are inherent when children and adults receive the same pneumococcal vaccines.”
READ MORE: Pneumococcal Resource Center
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