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Cost-effectiveness of adult pneumococcal vaccination policies in underserved minorities aged 50–64 years compared to the US general population

Published on Mar 1, 2019in Vaccine3.269
· DOI :10.1016/j.vaccine.2019.01.002
Angela R. Wateska16
Estimated H-index: 16
(University of Pittsburgh),
Mary Patricia Nowalk36
Estimated H-index: 36
(University of Pittsburgh)
+ 4 AuthorsKenneth J. Smith27
Estimated H-index: 27
(University of Pittsburgh)
Sources
Abstract
Abstract Background Changing pneumococcal disease epidemiology due to childhood vaccination has prompted re-examination of US adult pneumococcal vaccination policies, as have considerations of greater pneumococcal disease incidence and higher prevalence of conditions that increase risk in underserved minority populations. Prior analyses suggest routine pneumococcal vaccination at age 50 could be considered, which could disproportionately benefit underserved populations. Methods A Markov cohort model estimated the cost-effectiveness of US pneumococcal vaccination policies in hypothetical 50-year-old underserved minority and general population cohorts. Strategies included receiving one or both available pneumococcal vaccines based on age- or chronic condition-specific criteria. US databases and medical literature data calibrated pneumococcal illness incidence, vaccine serotype distributions, age- and race-specific chronic condition distributions, and costs. Black population data were used as a proxy for underserved minorities. We took a US healthcare perspective, discounting at 3%/year. One-way and probabilistic sensitivity analyses were performed and scenarios modeling differing vaccine assumptions were examined. Results In both black and general population 50-year-olds, giving both pneumococcal vaccines to all 50-year-olds prevented the most disease, but cost >$250,000 per quality adjusted life year (QALY) gained. Current CDC recommendations (both vaccines for the immunocompromised, polysaccharide vaccine for other high-risk conditions) were economically favorable in either population when analyses assumed polysaccharide vaccine was ineffective against nonbacteremic pneumococcal pneumonia (NBP) . If polysaccharide vaccine is effective against NBP or if less complex age-based vaccination recommendations result in increased vaccine uptake, giving polysaccharide vaccine to all 50-year-olds cost Conclusions Despite changes in pneumococcal epidemiology, current CDC recommendations were favored in underserved minority and general population cohorts. Polysaccharide vaccine for all 50-year-olds could be considered under some vaccine uptake and effectiveness assumptions, particularly if mitigating racial health disparities in pneumococcal disease is a priority.
  • References (31)
  • Citations (1)
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References31
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#1Eun Ji Kim (Hofstra University)H-Index: 4
#2Taekyu Kim (Harvard University)H-Index: 2
Last. Amresh D. Hanchate (BU: Boston University)H-Index: 17
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Background There exist racial and ethnic disparities in the prevalence of chronic medical illnesses. However, it is unclear if the disparities arise from patients’ self-reported estimates on these diseases and whether there is an association between healthcare utilization and diagnosis.
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#1Marie-Josée J. Mangen (UU: Utrecht University)H-Index: 27
#2Susanne M. Huijts (UU: Utrecht University)H-Index: 12
Last. G. Ardine de Wit (UU: Utrecht University)H-Index: 30
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The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period. In a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in c...
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35 CitationsSource
#1W. W. WilliamsH-Index: 11
#2Peng-jun LuH-Index: 29
Last. Amy Parker FiebelkornH-Index: 15
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138 CitationsSource
#1Isaac See (CDC: Centers for Disease Control and Prevention)H-Index: 9
#2Paul Wesson (University of California, Berkeley)H-Index: 4
Last. Jennifer Ahern (University of California, Berkeley)H-Index: 44
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13 CitationsSource
#1Tamara Pilishvili (CDC: Centers for Disease Control and Prevention)H-Index: 21
#2Ryan Gierke (CDC: Centers for Disease Control and Prevention)H-Index: 5
Last. Cynthia G. Whitney (CDC: Centers for Disease Control and Prevention)H-Index: 67
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#1Roland J. Thorpe (Johns Hopkins University)H-Index: 28
#2Ruth G. Fesahazion (Johns Hopkins University)H-Index: 4
Last. Thomas A. LaVeist (Johns Hopkins University)H-Index: 51
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The weathering hypothesis, an explanation for race disparities in the USA, asserts that the health of African Americans begin to deteriorate prematurely compared to whites as a consequence of long-term exposure to social and environmental risk factors. Using data from 2000–2009 National Health Interview Surveys (NHIS), we sought to describe differences in age-related health outcomes in 619,130 African Americans and whites. Outcome measures included hypertension, diabetes, stroke, and cardiovascu...
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#1Adriaan Blommaert (University of Antwerp)H-Index: 8
#2Joke Bilcke (University of Antwerp)H-Index: 19
Last. Philippe Beutels (UNSW: University of New South Wales)H-Index: 40
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Abstract Background A recent trial demonstrated the 13 valent conjugate pneumococcal vaccine (PCV13) to be effective against invasive and non-invasive pneumococcal disease in healthy adults. PCV13 might therefore be considered as an alternative to the 23 valent polysaccharide vaccine (PPV23). Aim To explore the cost-effectiveness of vaccinating healthy adults over 50, with either PCV13 or PPV23 alone, or with a combined strategy using both PCV13 and PPV23. Methods A static multi-cohort model was...
19 CitationsSource
#1Charles Stoecker (Tulane University)H-Index: 7
#2Lindsay Kim (CDC: Centers for Disease Control and Prevention)H-Index: 8
Last. Tamara Pilishvili (CDC: Centers for Disease Control and Prevention)H-Index: 21
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BACKGROUND Recently released results from a randomized controlled trial have shown that 13-valent pneumococcal conjugate vaccine (PCV13) is efficacious against vaccine-type nonbacteremic pneumonia in adults.
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#1Lois Privor-Dumm (Johns Hopkins University)H-Index: 7
#2Prarthana Vasudevan (Johns Hopkins University)
Last. Jaya Gupta (Johns Hopkins University)H-Index: 1
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Abstract The global population of adults over 65 years of age is growing rapidly and is expected to double by 2050. Countries will face substantial health, economic and social burden deriving from vaccine-preventable diseases (VPDs) such as influenza, pneumonia and herpes zoster in older adults. It will be essential that countries utilize several public health strategies, including immunization. Understanding the different approaches countries have taken on adult immunization could help provide ...
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#1Jason LeblancH-Index: 7
#2May ElsherifH-Index: 8
Last. Walter Demczuk (Public Health Agency of Canada)H-Index: 15
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Background In Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age. Methods Surveil...
4 CitationsSource
#1Angela R. Wateska (University of Pittsburgh)H-Index: 16
#2Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
Last. Kenneth J. Smith (University of Pittsburgh)H-Index: 27
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BACKGROUND/OBJECTIVES: Recently revised vaccination recommendations for US adults, aged 65 years and older, include both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost-effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear. DESIGN: Markov decision analysis....
Source
#1Angela R. Wateska (University of Pittsburgh)H-Index: 16
#2Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
Last. Kenneth J. Smith (University of Pittsburgh)H-Index: 27
view all 7 authors...
Source
#1Angela R. Wateska (University of Pittsburgh)H-Index: 16
#2Mary Patricia Nowalk (University of Pittsburgh)H-Index: 36
Last. Kenneth J. Smith (University of Pittsburgh)H-Index: 27
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Introduction Recommending both the conjugate and polysaccharide pneumococcal vaccines to all U.S. seniors may have little public health impact and be economically unreasonable. Public health impact and cost-effectiveness of using both vaccines in all adults aged ≥65 years were estimated compared with an alternative strategy (omitting pneumococcal conjugate vaccine in the nonimmunocompromised) and with the newly revised recommendation (giving or omitting conjugate vaccine based on patient–physici...
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