Cost-effectiveness of vaccination against pneumococcal infection of adults at risk within the federal and regional programs

Abstract

The aim of the work was to evaluate the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) and its combination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) of immunocompetent adult patients with different levels of risk of pneumococcal infection. Material and methods. Cost-effectiveness analysis was carried out by a modeling method with a horizon of 15 years from the position of the healthcare system and taking into account the social perspective. The analysis was performed for 20, 40, and 60 year old patients with 1, 2, and 3 risk factors. In accordance with national recommendations, the vaccination regimen included the introduction of PCV13 (1 dose) + 1 dose of PPV23 one year later. In addition, the analysis was performed for vaccination with 1 dose of PCV13. The efficacy of PСV13 and PPV23 in different age groups corresponded to the results of foreign studies, taking into account the data of a Russian study of the serotypic landscape of pneumococci with community-acquired pneumonia, which required hospitalization. The cost of treating pneumococcal infections was calculated on the basis of the mandatory medical insurance rates in St. Petersburg for 2019. The cost of vaccination for federal programs was calculated on the basis of the PСV13 price of 1199 rubles per dose, and for regional programs – 1518.63 rubles per dose. The cost of PPV23 in both cases corresponded to the weighted average price of auctions for 2019 (1639 rubles per dose). Indirect costs were calculated on the basis of data on average wages in the Russian Federation and employment of citizens of various age groups. Сosts and life expectancy were discounted at 3.5% per year. Results. The number of cases of infection prevented and the amount of costs averted increase with increasing risk level. Moreover, with age, the number of deaths caused by these diseases increases significantly. The volume of prevented direct medical and general costs per 1 vaccinated patient varies from 0.41-2.95 thousand rubles and 1.00-6.82 thousand rubles, respectively. Vaccination of patients with 3 risk factors is most cost-effective. Conclusion. When analyzed from the perspective of the healthcare system, vaccination against pneumococcal infection with PCV13+PPV23 in 60-year-old patients with at least 1 risk factor and patients of any age with at least 2 risk factors can be considered as cost-effective. Vaccination with 1 dose of PCV13 of patients of any age with at least 1 risk factor in the analysis from the perspective of the healthcare system can be considered as a cost-effective intervention.