Health and economic impact of 20-valent pneumococcal conjugate vaccine for adults aged 66–84 years in Japan and Shiga prefecture

Abstract

Background: The Japanese National Immunization Program against pneumococcal disease (PD) includes 23-valent pneumococcal polysaccharide vaccine (PPSV23) but does not provide vaccination for adults aged ≥66 years. We evaluated the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) in adults aged 66–84 years with no history of PPSV23 vaccination in Japan and assessed the potential economic and health impact of introducing PCV20 on the local government (specifically, Shiga prefecture). Research design and methods: Using a Markov model, we assessed lifetime costs, quality-adjusted life-years (QALYs), and number of prevented cases and deaths caused by PD. Results: In national-level analysis, PCV20 was cost-effective compared with no vaccination under incremental cost-effectiveness ratio threshold of Japanese yen (JPY) 5,000,000/QALY, i.e. JPY1,677,401/QALY and JPY1,351,811/QALY from payer and societal perspectives, respectively. PCV20 was dominant (less costly and more effective) compared with PPSV23. In local-level analysis, the introduction of PCV20 required initial costs but resulted in greater cost savings related to medical expenses (-JPY424 and -JPY430 per person) and nursing care (-JPY560 and -JPY575 per person) compared to PPSV23 and no vaccination, respectively. Conclusions: PCV20 is cost-effective compared with PPSV23 and no vaccination in adults aged 66–84 years, which could reduce the future healthcare burden in Japan.