Community-acquired pneumonia cost-effectiveness of therapy: Difference between revisions
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{{CMG}}; {{AE}} Rebecca Cohen | |||
==Overview== | |||
Prevention of [[pneumococcal]] disease has evolved considerably with the creation of new forms of [[pneumococcal conjugate vaccine]]s (PCV) as well as further research into the efficacy of [[vaccination]]s in targeting and preventing different forms of the disease, such as nonbacterial and bacterial pneumococcal pneumonia. Former [[CDC]] vaccination recommendations of PPSV23 and PCV7 have been replaced with new vaccination strategy recommendations including both PPSV23 and the effective, broader coverage offered by PCV13. With these drugs approved by the FDA, the question of the cost-effectiveness of these vaccines for use on a broader scale in national vaccination programs is important to consider. | |||
==Cost effectiveness of therapy== | |||
Since 1983, PPSV23 has been recommended as a vaccination strategy for the prevention of invasive pneumococcal disease in adults <ref name="pmid22357831">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK| title=Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. | journal=JAMA | year= 2012 | volume= 307 | issue= 8 | pages= 804-12 | pmid=22357831 | doi=10.1001/jama.2012.169 | pmc=PMC3924773 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357831 }} </ref>. Then the CDC recommended vaccination with PCV7, which protected against seven [[serotype]]s, as the a protective measure against pneumococcal disease. | |||
Following its FDA approval in late 2011 and successful clinical trials <ref name="pmid25785969">{{cite journal| author=Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S et al.| title=Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 12 | pages= 1114-25 | pmid=25785969 | doi=10.1056/NEJMoa1408544 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25785969 }} </ref><ref name="pmid22357831">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK| title=Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. | journal=JAMA | year= 2012 | volume= 307 | issue= 8 | pages= 804-12 | pmid=22357831 | doi=10.1001/jama.2012.169 | pmc=PMC3924773 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357831 }} </ref>, PCV13 became the recommended treatment regimen. PCV13 protects against 6 additional serotypes that are not targeted by PCV7, thus reducing the number of cases of bacterial pneumococcus as well as associated medical treatment costs <ref name="pmid23312274">{{cite journal| author=Klok RM, Lindkvist RM, Ekelund M, Farkouh RA, Strutton DR| title=Cost-effectiveness of a 10- versus 13-valent pneumococcal conjugate vaccine in Denmark and Sweden. | journal=Clin Ther | year= 2013 | volume= 35 | issue= 2 | pages= 119-34 | pmid=23312274 | doi=10.1016/j.clinthera.2012.12.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23312274 }} </ref> and deaths. PCV13 was found to be effective in preventing vaccine-type pneumococcal disease and vaccine-type nonbacterial, bacterial, and pneumococcal [[pneumonia]], though it was not an effective vaccine for preventing any cause [[community-acquired pneumonia]] <ref name="pmid25785969">{{cite journal| author=Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S et al.| title=Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 12 | pages= 1114-25 | pmid=25785969 | doi=10.1056/NEJMoa1408544 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25785969 }} </ref>. Furthermore, PCV13 increased quality adjusted life years (QALYs) more than alternative vaccines like PCV10 and PCV7 <ref name="pmid22085813">{{cite journal| author=Strutton DR, Farkouh RA, Earnshaw SR, Hwang S, Theidel U, Kontodimas S et al.| title=Cost-effectiveness of 13-valent pneumococcal conjugate vaccine: Germany, Greece, and The Netherlands. | journal=J Infect | year= 2012 | volume= 64 | issue= 1 | pages= 54-67 | pmid=22085813 | doi=10.1016/j.jinf.2011.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085813 }} </ref><ref name="pmid23826268">{{cite journal| author=Ayieko P, Griffiths UK, Ndiritu M, Moisi J, Mugoya IK, Kamau T et al.| title=Assessment of health benefits and cost-effectiveness of 10-valent and 13-valent pneumococcal conjugate vaccination in Kenyan children. | journal=PLoS One | year= 2013 | volume= 8 | issue= 6 | pages= e67324 | pmid=23826268 | doi=10.1371/journal.pone.0067324 | pmc=PMC3691111 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23826268 }} </ref>. Due to its direct and indirect effects, PCV13 is a cost-effective vaccine for pneumococcal disease <ref name="pmid23826268">{{cite journal| author=Ayieko P, Griffiths UK, Ndiritu M, Moisi J, Mugoya IK, Kamau T et al.| title=Assessment of health benefits and cost-effectiveness of 10-valent and 13-valent pneumococcal conjugate vaccination in Kenyan children. | journal=PLoS One | year= 2013 | volume= 8 | issue= 6 | pages= e67324 | pmid=23826268 | doi=10.1371/journal.pone.0067324 | pmc=PMC3691111 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23826268 }} </ref><ref name="pmid23312274">{{cite journal| author=Klok RM, Lindkvist RM, Ekelund M, Farkouh RA, Strutton DR| title=Cost-effectiveness of a 10- versus 13-valent pneumococcal conjugate vaccine in Denmark and Sweden. | journal=Clin Ther | year= 2013 | volume= 35 | issue= 2 | pages= 119-34 | pmid=23312274 | doi=10.1016/j.clinthera.2012.12.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23312274 }} </ref><ref name="pmid23498103">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK| title=Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults. | journal=Am J Prev Med | year= 2013 | volume= 44 | issue= 4 | pages= 373-81 | pmid=23498103 | doi=10.1016/j.amepre.2012.11.035 | pmc=PMC3601581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23498103 }} </ref> and could potentially be a cost-effective candidate for a national immunization program <ref name="pmid22085813">{{cite journal| author=Strutton DR, Farkouh RA, Earnshaw SR, Hwang S, Theidel U, Kontodimas S et al.| title=Cost-effectiveness of 13-valent pneumococcal conjugate vaccine: Germany, Greece, and The Netherlands. | journal=J Infect | year= 2012 | volume= 64 | issue= 1 | pages= 54-67 | pmid=22085813 | doi=10.1016/j.jinf.2011.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085813 }} </ref>. PCV13 is an especially cost-effective candidate for bacterial pneumococcus prevention when compared to no vaccination in regions where the additional serotypes targeted by PCV13 are prevalent <ref name="pmid21621575">{{cite journal| author=Urueña A, Pippo T, Betelu MS, Virgilio F, Giglio N, Gentile A et al.| title=Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina. | journal=Vaccine | year= 2011 | volume= 29 | issue= 31 | pages= 4963-72 | pmid=21621575 | doi=10.1016/j.vaccine.2011.04.111 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21621575 }} </ref>. | |||
The other vaccine recommended by the CDC for prevention of pneumococcus is the [[pneumococcal polysaccharide vaccine]], PPSV23. Because it targets even more serotypes than PCV13, PPSV23 is more effective at preventing bacterial pneumococcus. Thus, [[herd immunity]] may increase even more with mass vaccination with PPSV23 compared to PCV13 simply because of the inclusion of additional serotypes <ref name="pmid23498103">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK| title=Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults. | journal=Am J Prev Med | year= 2013 | volume= 44 | issue= 4 | pages= 373-81 | pmid=23498103 | doi=10.1016/j.amepre.2012.11.035 | pmc=PMC3601581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23498103 }} </ref>. However, PPSV23 has no clear effect on nonbacterial pneumococcus, which is a more common form of pneumococcal disease. For this reason, it is a slightly less cost-effective candidate for mass vaccination, with $34600 per QALY for PPSV23 compared to $28900 per QALY for PCV13 <ref name="pmid22357831">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK| title=Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. | journal=JAMA | year= 2012 | volume= 307 | issue= 8 | pages= 804-12 | pmid=22357831 | doi=10.1001/jama.2012.169 | pmc=PMC3924773 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357831 }} </ref><ref name="pmid23498103">{{cite journal| author=Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK| title=Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults. | journal=Am J Prev Med | year= 2013 | volume= 44 | issue= 4 | pages= 373-81 | pmid=23498103 | doi=10.1016/j.amepre.2012.11.035 | pmc=PMC3601581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23498103 }} </ref>. At this QALY level, however, PPSV23 is still considered to be a cost-effective vaccination option for prevention of pneumococcal disease. | |||
PCV13 and PPSV23 are both thought to be cost-effective pneumococcal vaccines, though they both protect against pneumococcal disease differently. Currently, the CDC recommends PCV13 vaccination for children, immunocompromized individuals at least 19 years of age, and routine vaccination for adults over 65. Additionally, they recommend adults over 65 are vaccinated with a single dose of PPSV23 <ref name="pmid25233284">{{cite journal| author=Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG et al.| title=Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). | journal=MMWR Morb Mortal Wkly Rep | year= 2014 | volume= 63 | issue= 37 | pages= 822-5 | pmid=25233284 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25233284 }} </ref>. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:26, 10 July 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rebecca Cohen
Overview
Prevention of pneumococcal disease has evolved considerably with the creation of new forms of pneumococcal conjugate vaccines (PCV) as well as further research into the efficacy of vaccinations in targeting and preventing different forms of the disease, such as nonbacterial and bacterial pneumococcal pneumonia. Former CDC vaccination recommendations of PPSV23 and PCV7 have been replaced with new vaccination strategy recommendations including both PPSV23 and the effective, broader coverage offered by PCV13. With these drugs approved by the FDA, the question of the cost-effectiveness of these vaccines for use on a broader scale in national vaccination programs is important to consider.
Cost effectiveness of therapy
Since 1983, PPSV23 has been recommended as a vaccination strategy for the prevention of invasive pneumococcal disease in adults [1]. Then the CDC recommended vaccination with PCV7, which protected against seven serotypes, as the a protective measure against pneumococcal disease.
Following its FDA approval in late 2011 and successful clinical trials [2][1], PCV13 became the recommended treatment regimen. PCV13 protects against 6 additional serotypes that are not targeted by PCV7, thus reducing the number of cases of bacterial pneumococcus as well as associated medical treatment costs [3] and deaths. PCV13 was found to be effective in preventing vaccine-type pneumococcal disease and vaccine-type nonbacterial, bacterial, and pneumococcal pneumonia, though it was not an effective vaccine for preventing any cause community-acquired pneumonia [2]. Furthermore, PCV13 increased quality adjusted life years (QALYs) more than alternative vaccines like PCV10 and PCV7 [4][5]. Due to its direct and indirect effects, PCV13 is a cost-effective vaccine for pneumococcal disease [5][3][6] and could potentially be a cost-effective candidate for a national immunization program [4]. PCV13 is an especially cost-effective candidate for bacterial pneumococcus prevention when compared to no vaccination in regions where the additional serotypes targeted by PCV13 are prevalent [7].
The other vaccine recommended by the CDC for prevention of pneumococcus is the pneumococcal polysaccharide vaccine, PPSV23. Because it targets even more serotypes than PCV13, PPSV23 is more effective at preventing bacterial pneumococcus. Thus, herd immunity may increase even more with mass vaccination with PPSV23 compared to PCV13 simply because of the inclusion of additional serotypes [6]. However, PPSV23 has no clear effect on nonbacterial pneumococcus, which is a more common form of pneumococcal disease. For this reason, it is a slightly less cost-effective candidate for mass vaccination, with $34600 per QALY for PPSV23 compared to $28900 per QALY for PCV13 [1][6]. At this QALY level, however, PPSV23 is still considered to be a cost-effective vaccination option for prevention of pneumococcal disease.
PCV13 and PPSV23 are both thought to be cost-effective pneumococcal vaccines, though they both protect against pneumococcal disease differently. Currently, the CDC recommends PCV13 vaccination for children, immunocompromized individuals at least 19 years of age, and routine vaccination for adults over 65. Additionally, they recommend adults over 65 are vaccinated with a single dose of PPSV23 [8].
References
- ↑ 1.0 1.1 1.2 Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK (2012). "Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine". JAMA. 307 (8): 804–12. doi:10.1001/jama.2012.169. PMC 3924773. PMID 22357831.
- ↑ 2.0 2.1 Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S; et al. (2015). "Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults". N Engl J Med. 372 (12): 1114–25. doi:10.1056/NEJMoa1408544. PMID 25785969.
- ↑ 3.0 3.1 Klok RM, Lindkvist RM, Ekelund M, Farkouh RA, Strutton DR (2013). "Cost-effectiveness of a 10- versus 13-valent pneumococcal conjugate vaccine in Denmark and Sweden". Clin Ther. 35 (2): 119–34. doi:10.1016/j.clinthera.2012.12.006. PMID 23312274.
- ↑ 4.0 4.1 Strutton DR, Farkouh RA, Earnshaw SR, Hwang S, Theidel U, Kontodimas S; et al. (2012). "Cost-effectiveness of 13-valent pneumococcal conjugate vaccine: Germany, Greece, and The Netherlands". J Infect. 64 (1): 54–67. doi:10.1016/j.jinf.2011.10.015. PMID 22085813.
- ↑ 5.0 5.1 Ayieko P, Griffiths UK, Ndiritu M, Moisi J, Mugoya IK, Kamau T; et al. (2013). "Assessment of health benefits and cost-effectiveness of 10-valent and 13-valent pneumococcal conjugate vaccination in Kenyan children". PLoS One. 8 (6): e67324. doi:10.1371/journal.pone.0067324. PMC 3691111. PMID 23826268.
- ↑ 6.0 6.1 6.2 Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK (2013). "Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults". Am J Prev Med. 44 (4): 373–81. doi:10.1016/j.amepre.2012.11.035. PMC 3601581. PMID 23498103.
- ↑ Urueña A, Pippo T, Betelu MS, Virgilio F, Giglio N, Gentile A; et al. (2011). "Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina". Vaccine. 29 (31): 4963–72. doi:10.1016/j.vaccine.2011.04.111. PMID 21621575.
- ↑ Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG; et al. (2014). "Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Morb Mortal Wkly Rep. 63 (37): 822–5. PMID 25233284.