PPSV23 Provides Cost-Effective Option for Older Adults

New research demonstrates that the 23-valent pneumococcal polysaccharide vaccine (PPSV23) remains a highly cost-effective intervention for adults aged 50 and older, offering a vital tool for public health specialists and frontline pharmacists, according to a study in Infectious Medicine.¹

“Streptococcus pneumoniae (S. pneumoniae) is a gram-positive, catalase-negative species of bacterium responsible for most bacterial pneumonia cases globally and affects approximately 39% of individuals in the US aged 65 and older with a chronic medical condition,” according to authors of a study published in Pathogens.² “S. pneumoniae is commonly spread through respiratory droplets and colonizes in the upper respiratory tract. The ability of S. pneumoniae to spread through the air makes it one of the most commonly spread diseases.”

A recent cost-effectiveness analysis conducted in China found that a strategy of PPSV23 vaccination at age 50, followed by a revaccination at age 65, could prevent 1115 cases of pneumococcal disease and 35 deaths per 100,000 patients. The study indicates that PPSV23 is cost-effective at willingness-to-pay (WTP) thresholds of 2 to 3 times the national gross domestic product (GDP) per capita, supported by a favorable post-marketing safety profile with no unexpected adverse events identified.¹

For pharmacists, who are increasingly recognized by the CDC as the most accessible point of care for adult immunizations, these findings underscore the enduring value of polysaccharide vaccines.³

READ MORE: Co-Administration of PCV13 and PPSV23 Provides Superior Pneumococcal Immunogenicity

The economic argument for widespread vaccination is reinforced by the biological vulnerability inherent in the aging process. As adults pass the age of 50, they undergo “inflammaging”—a chronic low-grade inflammation that impairs dendritic cell function and reduces the ability of the immune system to respond to new antigens.²

This is compounded by thymus involution, which limits T-cell production and leaves older adults significantly more susceptible to S. pneumoniae, the leading cause of pneumonia-related deaths among the elderly. Because this pathogen can mutate into over 100 different serotypes and utilize phase variation to evade immune detection, the broad serotype coverage provided by PPSV23 is essential for preventing invasive diseases.

While the global efficacy of PPSV23 against invasive pneumococcal disease is estimated at 63%, it remains a cornerstone of prevention for those at high risk of serious illness and death.^2,3

The role of the pharmacist in this landscape is expanding, yet it remains sensitive to a shifting policy environment. Recent legislative updates in the US highlight this volatility, with states like Missouri and Rhode Island currently debating or updating the specific range of vaccines that pharmacists are authorized to order and administer, according to the University of Minnesota.⁴

Furthermore, some states are moving to decouple their vaccine requirements from federal guidance, emphasizing the importance of independent clinical recommendations. This authority is critical because older individuals, who make up a large percentage of hospital patients, are particularly vulnerable to hospital-acquired pneumococcal infections, which can account for up to 15% of all hospital-acquired infections.^2,4

While PPSV23 is a proven cost-effective option, it is often compared with conjugate vaccines in clinical and economic models. Research from Thailand, for example, found that while PPSV23 provided significant quality-adjusted life year gains over no vaccination, the 13-valent pneumococcal conjugate vaccine (PCV13) was often considered a “best buy” due to its higher efficacy against non-bacteremic pneumonia, according to Frontiers in Public Health.⁵

Nevertheless, high out-of-pocket costs remain a significant barrier to implementation in many regions, making the relative affordability of PPSV23 an important factor for national immunization programs. Beyond individual health, these vaccines provide broader societal benefits by protecting families against catastrophic medical expenses that can lead to poverty.^5,6

Vaccination also serves as a primary defense against the growing threat of antimicrobial resistance, which is projected to cause 10 million deaths annually by 2050 if left unchecked. By preventing both sensitive and resistant infections, vaccines like PPSV23 reduce the overall demand for antibiotics, which is vital as S. pneumoniae shows increasing resistance to common drug classes like penicillin and macrolides.^2,6

As the US vaccine policy environment faces new challenges and leadership changes at the Department of Health and Human Services (HHS), pharmacists must remain informed of the latest cost-effectiveness data to advocate for their patients.⁴

The China study reaffirms that PPSV23 provides a robust and economical defense for an aging population facing a highly adaptable and dangerous pathogen.^1,2

“Our analysis reveals that among individuals aged 50 in China, the PPSV23 vaccine not only effectively prevents more pneumococcal-related diseases compared with no vaccination but also exhibits substantial cost-effectiveness at higher WTP thresholds (eg, 2 to 3 times GDP per capita),” concluded authors of the current study.¹ “These findings provide valuable insights for optimizing and implementing vaccination strategies.”

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Shu Y, Tan S, Chen Y, et al. Cost-effectiveness analysis of 23-valent pneumococcal polysaccharide vaccine for adults in China. Infect Med. April 27, 2026:100258. https://doi.org/10.1016/j.imj.2026.100258

2. Kang N, Subramanian VS, Agrawal A. Influence of aging and immune alterations on susceptibility to pneumococcal pneumonia in the elderly. Pathogens. 2025 Jan 8;14(1):41. doi: 10.3390/pathogens14010041.

3. Pneumococcal vaccination. CDC. February 25, 2026. Accessed April 29, 2026. https://www.cdc.gov/pneumococcal/vaccines/index.html

4. Brandstetter Figueroa I, Steier J. The state of US vaccine policy. University of Minnesota. April 28, 2026. Accessed April 29, 2026. https://www.cidrap.umn.edu/childhood-vaccines/state-us-vaccine-policy-apr-28-2026

5. Ngamprasertchai T, Kositamongkol C, Lawpoolsri S, et al. A cost-effectiveness analysis of the 13-valent pneumococcal conjugated vaccine and the 23-valent pneumococcal polysaccharide vaccine among Thai older adult. Front Public Health. 2023 Jun 29;11:1071117. doi: 10.3389/fpubh.2023.1071117.

6. Nandi A, Shet A. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Hum Vaccin Immunother. 2020 Aug 2;16(8):1900-1904. doi: 10.1080/21645515.2019.1708669. Epub 2020 Jan 24.