Cost-effectiveness and return on investment of 20-valent pneumococcal conjugate vaccine use among adults in England: analysis from the societal perspective

BACKGROUND: Pneumococcal disease burden remains high in England despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) among all adults ≥65 years and those aged 18–64 years with risk conditions. We conducted cost-effectiveness (CE) and return on investment (ROI) analyses of adult vaccination with the available 20-valent pneumococcal conjugate vaccine (PCV20) to estimate societal net benefit associated use of PCV20 versus PPV23 in the current programme. METHODS: A probabilistic cohort model projected lifetime risks and costs of invasive pneumococcal disease (IPD) and all-cause community-acquired pneumonia (CAP) and expected impact of vaccination. Population included adults aged 18–64 years with risk conditions and all adults aged 65–99 years (N = 15,900,480). Inputs were based on publicly available data. Clinical outcomes included cases of IPD, CAP, and associated deaths. Economic costs included direct medical care and non-medical care costs. Analyses were conducted from the societal perspective (discounting, 3.5%/year). CE and ROI were estimated as cost per quality-adjusted life year (QALY) gained and averted total costs, respectively. An opportunity cost scenario and probabilistic sensitivity analyses were undertaken. RESULTS: Replacing PPV23 with PCV20 would prevent 10,196 IPD cases, 169,738 inpatient CAP cases, 74,707 outpatient CAP cases, and 27,259 pneumococcal-related deaths, increasing QALYs by 114,763. Total medical care costs decreased by £1,017·0 M and non-medical care costs by £144·0 M, and vaccination costs increased by £378·7 M. PCV20 yielded net savings of £782·3 M, and hence was dominant (vs. PPV23), with ROI of £3.1 for every £1 invested. Adjusting opportunity costs associated with suboptimal resource use in periods of excess demand on National Health Service increased total savings to £1,864·2 M and ROI to £5.9 per £1 invested. CONCLUSIONS: Our findings suggest that use of PCV20—in lieu of PPV23—among all adults aged ≥65 years and those aged 18–64 years with underlying risk conditions in England will be cost-saving and have a substantial net benefit to society.