Just before the end of 2011, the FDA approved an adult indication for Prevnar 13 Prevnar 13 -- a conjugate containing a pneumococcal bacteria bound to a protein to help the body’s immune system recognize the bacteria and will have a longer lasting immune response. (Currently the only vaccine for pneumococcal bacteria approved in the United States for adults 50 years of age or older is Pneumovax which is only effective against invasive pneumonia and not effective on the more common, pneumococcal pneumonia.)
But at the ACIP meeting (that begins tomorrow and runs through Thursday), there is only a discussion of the 13-valent pneumococcal conjugate vaccine. Just a discussion. While that’s important, a positive recommendation is crucial. Otherwise it is, in many unfortunate respects, just talk.
Coincidentally, today a new study in JAMA (just released today) points to not only the therapeutic benefit of this new adult indication – but also to its cost effectiveness.
A computer-based cost-effectiveness analysis in the February 22/29 issue of JAMA suggests that use of the 13-valent pneumococcal conjugate vaccine (PCV13) might prevent more pneumococcal disease compared with the current 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination recommendations -- while remaining economically reasonable.
Kenneth J. Smith, M.D., M.S., of the University of Pittsburgh School of Medicine, and colleagues conducted a study to estimate the effectiveness and cost-effectiveness of pneumococcal vaccination strategies among adults 50 years of age and older. Using various modeling techniques, simulations were performed in hypothetical groups of U.S. 50-year-olds.
(Note: FDA gave pneumovax 50 years and older indication, ACIP recommendation is for 65 years old or older.)
With no vaccination, the estimated lifetime risk from age 50 years onward for hospitalized NPP was 9.3 percent, for IPD was 0.86 percent, and for death due to pneumococcal disease was 1.8 percent. Among the different vaccination strategies compared in the analysis, those using PPSV23 were estimated to prevent more IPD than strategies using only PCV13, while strategies using 2 scheduled PCV13 doses were estimated to prevent more NPP.
Regarding cost-effectiveness, in the base case scenario, administration of PCV13 as a substitute for PPSV23 in current recommendations (i.e., vaccination at age 65 years and at younger ages if co-existing illnesses are present) had an estimated cost of $28,900 per quality-adjusted life-year (QALY) gained compared with no vaccination and was more cost-effective than the currently recommended PPSV23 strategy.
With routine vaccine administration at ages 50 and 65 years, it was estimated that PCV13 costs $45,100 per QALY compared with PCV13 substituted in current recommendations. Administration of PCV13 at ages 50 and 65 years followed by PPSV23 at age 75 years was estimated to cost $496,000 per QALY gained.
The authors’ write that, “There are no absolute criteria for cost-effectiveness, but in general, interventions costing less than $20,000 per QALY gained are felt to have strong evidence for adoption, interventions costing $20,000 to $100,000 per QALY have moderate evidence, and those costing more than $100,000 per QALY have weaker evidence for adoption.”
In an accompanying editorial, Eugene D. Shapiro, M.D., of the Yale University School of Medicine, writes that this analysis provides a reasonable framework with which to approach this issue. “What does seem clear is that improvements in vaccines against pneumococci and increased rates of immunization likely will result in continued reductions in the incidence of infections due to this common pathogen.”
Any further questions?
