Cost-effectiveness analysis of the use of PNEU-C-21 in adults aged ≥50 years in Canada

This study analyzed the health and economic outcomes of the 21-valent pneumococcal conjugate vaccine (PNEU-C-21; CAPVAXIVE®) compared to either PNEU-C-20 or PNEU-P-23. Cohorts in the cost-effectiveness analyses included vaccine-naïve 57- and 65-year-olds and vaccine-experienced 70-year-olds. A published Markov model simulated the movement of the Canadian population among four health states: healthy, pneumococcal disease (invasive pneumococcal disease and community-acquired pneumonia attributed to S. pneumoniae), post-meningitis sequelae, and death. The model was populated with published literature and publicly available databases and/or reports. Model inputs included demographic data, epidemiologic data, serotype distribution, vaccine effectiveness, costs, and health-related utilities. The model used a lifetime horizon and 1.5% discounting of costs and life years. Key outcomes included the following: cases, deaths, costs, and incremental cost-effectiveness ratios. The PNEU-C-21 strategy prevented substantially more cases and deaths when compared to the PNEU-C-20 or PNEU-P-23 strategies. For both vaccine-naïve cohorts, the ICERs were dominant for both PNEU-C-21 vs. PNEU-C-20 and PNEU-C-21 vs. PNEU-P-23; among adults aged 70 years, previously vaccinated with PNEU-P-23, PNEU-C-21 was dominant over PNEU-C-20. These results demonstrate that PNEU-C-21 can prevent a substantial number of cases and deaths while remaining highly cost-effective over a range of inputs and scenarios in Canada.