Pneumococcal Burden Remains Despite Immunization Expansion
The Advisory Committee on Immunization Practices voted to lower the pneumococcal recommendation to 50 years in October 2024.
Investigators found that incorporating either the pneumococcal conjugate vaccine (PCV) 20 or PCV 15 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) had an incremental budget impact of $6.5 billion and $9 billion for adults aged 50 to 64 years, respectively. The impact was sensitive to the number of vaccines, costs per dose, vaccine coverage proportion, and pneumococcal treatment, according to results of the study published in BMC Public Health.1
The Advisory Committee on Immunization Practices voted to lower the pneumococcal recommendation to 50 years in October 2024. | Image Credit: kitsawet - stock.adobe.com
“Due to uncertainties around vaccine uptake in adults and its impact on epidemiological changes and cost of treatment, several scenarios were evaluated, with all favoring one dose of PCV20 over PCV15 followed by PPSV23,” the study authors said.1 “Expanding the pneumococcal program to the Black adults aged 50–64 years without high-risk conditions resulted in the budget increase of 850 million.”
According to the CDC, adults 50 years or older who have not received a pneumococcal conjugate vaccine or have an unknown vaccination history are recommended to receive PCV15, PCV20, or PCV21. If PCV15 is used, PPSV23 is administered 1 year later if needed. Previously, the vaccination recommendation was for patients 65 years and older, but the CDC Advisory Committee on Immunization Practices (ACIP) voted to lower the recommendation to 50 years in October 2024.2,3
In June 2024, the ACIP announced updates to the vaccine schedule to prevent invasive pneumococcal disease. In a unanimous vote, ACIP recommended the pneumococcal 21-valent conjugate vaccine (Capvaxive), which prevents invasive disease for Streptococcus pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B.4
The study investigators aimed to determine the impact of introducing PCV15 or PCV20 in the US for patients aged 50 to 64 years by comparing the budget impact compared with the high-risk populations. The analysis was conducted from the US payer perspective, which included only the direct costs associated with vaccines and treatment. The base year for the model was 2023, and the budget impact was projected from 2024 to 2026.1
The investigators estimated a total of 63 million patients being 50 to 64 years of age, with about 24 million having chronic conditions that were eligible to receive a pneumococcal vaccine. They stated that the vaccine uptake for patients in the age range with chronic conditions was approximately 23%, and the assumed vaccine uptake for those without chronic conditions would increase from approximately 10% to 30% in the 3-year period. As for the budget, the study authors assumed the cost per vaccine remained consistent. For the adoption case, vaccine uptake increased slowly to 53%, which meant the cost increased gradually.1
In the best-case scenario, the investigators stated that PCV20 alone would have a budget impact of $6.5 billion compared with $9 billion for the PCV15 and PPSV23 vaccines. In a subgroup analysis of a cohort of only Black patients, there would be an additional cost of 850 million over 3 years, and an incremental increase for the cost would be over $1.1 billion.1
“Despite ACIP (2023) recommendations that adults under 65 years old with risk factors receive either PCV20 or PCV15 (the latter followed one year later by PPSV23), substantial pneumococcal disease burden remained, particularly in healthy adults aged 50–64 years who could likely benefit from vaccination,” the study authors concluded.1
READ MORE: Pneumococcal Resource Center
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