EE204 Budgetary Impact of New Recommendations for Pneumococcal Vaccination of US Adults

US Advisory Committee on Immunization Practices (ACIP) recently updated adult pneumococcal immunization recommendations to include routine use of 20-valent pneumococcal conjugate vaccine (PCV20) alone or sequentially administered 15-valent PCV (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PCV15→PPSV23). We evaluated the budgetary impact of PCV20 alone and, alternatively, PCV15→PPSV23 compared with previous recommendations (i.e., age/risk dependent use of PPSV23 alone or 13-valent PCV followed by PPSV23 [PCV13→PPSV23]). Analyses were conducted using deterministic model to depict risks and costs of pneumococcal disease among US adults aged 19-64 years with underlying medical conditions and all adults aged 65-99 years (N=10M). Persons in model population were vaccinated at model entry or in subsequent years, or were never vaccinated. Clinical outcomes included invasive pneumococcal disease (IPD), inpatient and outpatient all-cause non-bacteremic pneumonia (NBP), and disease-related deaths. Economic costs included disease-related medical care and vaccination (acquisition and administration). Budgetary impact of new (vs. previous) recommendations was calculated as difference in total costs over a 5-year period. Compared with previous recommendations, PCV20 alone would prevent an additional 345 IPD cases, 1,956 inpatient and 2,834 outpatient NBP cases, and 156 disease-related deaths; with medical costs lower by $59.0M and vaccine costs higher by $120.0M, total budget impact was $61.0M overall or $0.52 per-member per-month (PMPM). Use of PCV15→PPSV23 in lieu of PCV20 alone would prevent fewer cases and deaths (191 IPD, 1,219 inpatient NBP, 1,813 outpatient NBP, and 91 deaths, vs. previous recommendations); with higher medical ($36.0M) and vaccination ($433.7M) costs, the total budgetary impact of PCV15→PPSV23 would also be higher ($397.7M overall or $3.42 PMPM). Both vaccination strategies included in new US ACIP pneumococcal immunization guidelines prevent additional cases of disease and disease-attributable deaths compared with previous recommendations. PCV20 alone, however, prevents more disease and deaths than the costlier alternative strategy involving PCV15→PPSV23.