Cost-effectiveness and return on investment of 20-valent pneumococcal conjugate vaccine use among adults in England: analysis from the societal perspective

Pneumococcal disease burden remains high in England despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) among all adults ≥65 years and those aged 18–64 years with risk conditions. We conducted cost-effectiveness (CE) and return on investment (ROI) analyses of adult vaccination with the available 20-valent pneumococcal conjugate vaccine (PCV20) to estimate societal net benefit associated use of PCV20 versus PPV23 in the current programme. A probabilistic cohort model projected lifetime risks and costs of invasive pneumococcal disease (IPD) and all-cause community-acquired pneumonia (CAP) and expected impact of vaccination. Population included adults aged 18–64 years with risk conditions and all adults aged 65–99 years (N = 15,900,480). Inputs were based on publicly available data. Clinical outcomes included cases of IPD, CAP, and associated deaths. Economic costs included direct medical care and non-medical care costs. Analyses were conducted from the societal perspective (discounting, 3.5%/year). CE and ROI were estimated as cost per quality-adjusted life year (QALY) gained and averted total costs, respectively. An opportunity cost scenario and probabilistic sensitivity analyses were undertaken. Replacing PPV23 with PCV20 would prevent 10,196 IPD cases, 169,738 inpatient CAP cases, 74,707 outpatient CAP cases, and 27,259 pneumococcal-related deaths, increasing QALYs by 114,763. Total medical care costs decreased by £1,017·0 M and non-medical care costs by £144·0 M, and vaccination costs increased by £378·7 M. PCV20 yielded net savings of £782·3 M, and hence was dominant (vs. PPV23), with ROI of £3.1 for every £1 invested. Adjusting opportunity costs associated with suboptimal resource use in periods of excess demand on National Health Service increased total savings to £1,864·2 M and ROI to £5.9 per £1 invested. Our findings suggest that use of PCV20—in lieu of PPV23—among all adults aged ≥65 years and those aged 18–64 years with underlying risk conditions in England will be cost-saving and have a substantial net benefit to society.