EE212 Cost-Effectiveness of Pneumococcal Vaccination Implementation in Older Adult Immunization Schedule in the Brazilian National Program

Pneumococcal disease is associated with high mortality and significant burden in older adults. No universal pneumococcal vaccination program is included in Brazil’s national immunization program (NIP) for older adults. This study aims to evaluate the cost-effectiveness of introducing a single-dose 23-valent polysaccharide vaccine (PPSV23) against pneumococcal disease for adults 60 years versus no vaccination (NV) from the Brazilian public payer perspective. A Markov model was developed to determine lifetime costs and consequences of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) of a 60-year-old unvaccinated cohort from 2022 until death. A vaccine coverage of 90% was assumed and the population was divided into healthy (58%), at risk (32%) and high-risk (10%) subgroups. A vaccine-serotype efficacy of 73% and 33.5%, for IPD and NBPP was applied, respectively, with a linear 9-year waning. Five health states were considered in the model: no pneumococcal disease, IPD, NBPP, post-meningitis sequelae and death. Costs and epidemiological parameters were estimated using Brazil-specific data. The costs and effectiveness values were discounted at 5%. Costs were converted to US dollars (1US$=R$5.14). ICERs were calculated by dividing the difference in accumulated costs by the quality-adjusted life year (QALY) gained. Amongst a cohort of 2.1 million 60-year-olds, vaccination with PPSV23 was estimated to prevent 719 cases of IPD, 6721 cases of NBPP, and 717 disease related deaths in comparison to the NV group. implementing the vaccine would save 14,057 life years at an incremental cost of about $ 18 million. The ICER was estimated to be $4,352 per QALY gained, hence the strategy was cost-effective. A single-dose PPSV23 for adults aged 60 years is a highly cost-effective strategy and leads to health gains and reduced mortality. Decision makers should consider pneumococcal vaccine as part of the older adult vaccination schedule in NIP.