Cost-effectiveness analysis of 23-valent pneumococcal polysaccharide vaccine for elderly in Zhejiang province, China

This study aimed to evaluate the cost-effectiveness of introducing 23-valent pneumococcal polysaccharide vaccine (PPV23) for elders into provincial immunization program in Zhejiang, China. From a societal perspective, a decision tree-Markov model was constructed to stimulate the economic and health consequences of Streptococcus pneumonae infection diseases in both 60-y-old and 70-y-old cohort, with one dose PPV23 vaccination and a coverage of 90% versus no vaccination. The model accounted for invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBP). Model parameters were obtained from up-to-date published literature and statistical data. The costs associated with vaccination and medical treatment, quality-adjusted life years (QALYs), the number of Spn infection cases averted, and the incremental cost-effectiveness ratio (ICER) were calculated. Both effects and costs were discounted by 3% annually. The sensitivity analysis was implemented to evaluate the robustness of the model. Compared to the no-vaccination, the PPV23 vaccination program could reduce the number of IPD case, NBP case, death by 9.56%, 3.93% and 6.72% in the 60-y-old cohort. The corresponding figures for the 70-y-old cohort were 20.96%, 30.22%, and 15.70%. The ICER was estimated at US$ 635.31/QALY and US$ 69.36/QALY for the 60-y-old and 70-y-old cohort, respectively, and these results were robust in sensitivity analyses. Introducing a vaccination program of PPV23 targeting both 60 y old and 70 y old was economical based on the parameters, having the potential to substantially reduce morbidity and mortality related to Spn and the related disease burden.