Ahuva Averin

Background: Use of 13-valent pneumococcal conjugate vaccine (PCV13) has reduced the burden of pneumococcal disease among both children and adults. Research has indicated that some population subgroups have benefited more than others. This study estimated rates of inpatient all-cause pneumonia among US adults by age, race, comorbidity profile, and household income (HHI), before and after universal recommendation for PCV13 in children and targeted recommendation for use in adults. Methods: A retrospective observational study was conducted using Optum's de-identified Clinformatics Data Mart Database (2007–2019). Adults aged ≥18 years were stratified by age, race, comorbidity profile (low-risk, at-risk/high-risk), and annual household income. Inpatient all-cause pneumonia episodes were identified via relevant International Classification of Diseases (Ninth and Tenth Revisions) codes. Rates per 100 000 person-years and incidence rate ratios (IRRs) were calculated for the pre-PCV13 (2008–2009), peri-PCV13 (2010–2012), post-PCV13#1 (2013–2016), and post-PCV13#2 (2017–2019) periods. Results: Among 38.7 million US adults, inpatient all-cause pneumonia rates decreased from the pre-PCV13 to post-PCV13#2 period among all age groups (eg, 72.9 to 38.2 among 18- to 49-year-olds and 1621.8 to 1326.0 among ≥75-year-olds). Irrespective of age, rates generally decreased from the pre-PCV13 to post-PCV13#2 period within subgroups defined by race, comorbidity profile, and HHI; the greatest relative reductions were observed among persons aged 18–49 years. During the post-PCV13#2 period, the highest rates of inpatient all-cause pneumonia persisted in Black adults, at-risk/high-risk adults, and adults with HHI <$100 000. Conclusions: Despite reductions in inpatient all-cause pneumonia following pediatric PCV13 introduction, residual disparities persist for Black, at-risk/high-risk, and low- and middle-income adults. Strategies to reduce persistent disparities in disease burden among affected adults should be considered and implemented.

Pneumococcal disease burden remains high in England despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) among all adults ≥65 y

Lacking national policy for adult pneumococcal vaccination, local Indian guidelines recommend 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV23). However, no vaccination ('NV') or PPV23 alone are most common in clinical practice. We evaluated cost-effectiveness of PCV13 versus NV and, alternatively, PPV23 in India. Cohort model with Markov-type process projected lifetime cases, deaths, and costs associated with invasive pneumococcal disease and all-cause non-bacteremic pneumonia (discounting = 5%/year). Cost per quality-adjusted life year (QALY) gained was assessed among at-risk/high-risk adults aged 50-59 years and all aged 60-99 years (N = 209.5 M) from private/patient and government/payer perspectives, which differed on medical costs, vaccination costs, and uptake rates. From private/patient perspective, PCV13 versus NV yielded ₹480,908/QALY (ΔCosts=₹27.2B;ΔQALYs = 56,560), whereas PCV13 was dominant versus PPV23 (ΔCosts=-₹359.1 M; ΔQALYs = 53,861).From government/payer perspective, corresponding ratios were ₹610,178/QALY (ΔCosts=₹84.4B;ΔQALYs = 138,382), and ₹456,048/QALY (ΔCosts=₹60.2B; ΔQALYs = 131,933). In probabilistic sensitivity analyses, cost-effectiveness was <₹600,000/QALY in 72.9%-99.7% of replications (N = 1000/analysis), depending on comparison/perspective. PCV13 versus NV among at-risk/high-risk adults aged 50-59 years and all aged ≥ 60 years would be cost-effective from both perspectives considering willingness-to-pay equaling approximately 3× gross domestic product/capita. Furthermore, PCV13 versus PPV23 would be cost-effective and cost saving from government/payer and private/patient perspectives, respectively.

The US Advisory Committee on Immunization Practices recommends use of bivalent stabilized prefusion F subunit vaccine (RSVpreF) among pregnant persons to protect their infants against lower respiratory tract illness due to RSV (RSV-LRTI). Using a cohort model depicting clinical outcomes and economic costs of RSV acute respiratory infection (RSV-ARI) among US infants from birth to age 1 year, we evaluated the impact of seasonally administered maternal RSVpreF versus no intervention. Outcomes included cases of medically attended RSV-ARI, RSV-related deaths, medical costs, and indirect costs. Costs were reported in 2023 US$. Among 3.7 million US infants aged <12 months each year, a total of 1,148,967 RSV-ARI cases (hospital: 48384; emergency department [ED]: 246,118; outpatient clinic [OC]: 854,465) were projected to occur, yielding total annual costs of $2.4 billion (direct: $1.7B; indirect: $0.7B). With 54.9% uptake, RSVpreF would prevent 89,908 cases (hospital: 10308; ED: 20538; OC: 59062), corresponding with a $368 million decrease (direct: $286 M; indirect: $81 M) in total 1-year costs. Even with limited uptake and without considering benefits to pregnant persons or reductions in RSV-related sequelae, maternal vaccination with RSVpreF would substantially reduce the public health and economic burden of RSV-ARI in US infants.

Introduction In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23; PCV13 → PPSV23) has been recommended for all adults aged ≥ 65 years and younger adults with chronic medical (“moderate-risk”) or immunocompromising (“high-risk”) conditions since 2017. With the approval of a 20-valent PCV (PCV20), we evaluated the cost-effectiveness of PCV20 versus current recommendations for moderate-/high-risk adults aged 18–64 years and all adults 65–99 years. Methods A probabilistic cohort model was used to project lifetime outcomes and costs associated with invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP), and the expected impact of vaccination. Clinical outcomes were projected annually based on Argentinean data. Economic costs were estimated based on cases and corresponding medical costs (adjusted to 2023 USD) and costs of vaccine and administration. Cost-effectiveness of PCV20 was evaluated versus the current strategy, PCV13 → PPSV23, and alternatively, versus sequentially administered 15-valent PCV and PPSV23 (PCV15 → PPSV23), and presented as cost per quality-adjusted life year gained; a healthcare system perspective was used. Costs and benefits were discounted at 3%/year. Results PCV20 in lieu of PCV13 → PPSV23 among moderate-/high-risk adults aged 18–64 years and all adults 65–99 years (N = 13.4M) prevented 3838 IPD, 4377 inpatient NBP, and 6003 outpatient NBP cases, and 1865 disease-related deaths; relative to PCV15 → PPSV23 the corresponding reductions were 2775, 3285, 4518, and 1348. PCV20 was projected to be the dominant strategy versus PCV13 → PPSV23 and PCV15 → PPSV23 as overall costs were lower by $87.6M and $80.8M, respectively. In probabilistic sensitivity analyses, PCV20 was dominant (i.e., more effective, less costly) in 100% of 1000 simulations. Conclusions Analyses suggest implementing a PCV20 vaccination program in moderate-/high-risk adults aged 18–64 years and all adults ≥ 65 years—in lieu of PCV13 → PPSV23—would yield substantial reductions in pneumococcal disease and would be cost saving to the Argentinean healthcare system.

Background: Estimates of the cost of medically attended lower respiratory tract illness (LRTI) due to respiratory syncytial virus (RSV) in adults, especially beyond the acute phase, is limited. This study was undertaken to estimate the attributable costs of RSV-LRTI among US adults during, and up to 1 year after, the acute phase of illness. Methods: A retrospective observational matched-cohort design and a US healthcare claims repository (2016–2019) were employed. The study population comprised adults aged ≥18 years with RSV-LRTI requiring hospitalization (RSV-H), an emergency department visit (RSV-ED), or physician office/hospital outpatient visit (RSV-PO/HO), as well as matched comparison patients. All-cause healthcare expenditures were tallied during the acute phase of illness (RSV-H: from admission through 30 days postdischarge; ambulatory RSV: during the episode) and long-term phase (end of acute phase to end of following 1-year period). Results: The study population included 4526 matched pairs of RSV-LRTI and comparison patients (RSV-H: n = 970; RSV-ED: n = 590; RSV-PO/HO: n = 2966). Mean acute-phase expenditures were $42 179 for RSV-H (vs $5154 for comparison patients), $4409 for RSV-ED (vs $377), and $922 for RSV-PO/HO (vs $201). By the end of the 1-year follow-up period, mean expenditures—including acute and long-term phases—were $101 532 for RSV-H (vs $36 302), $48 701 for RSV-ED (vs $27 131), and $28 851 for RSV-PO/HO (vs $20 523); overall RSV-LRTI attributable expenditures thus totaled $65 230, $21 570, and $8327, respectively. Conclusions: The cost of RSV-LRTI requiring hospitalization or ambulatory care among US adults is substantial, and the economic impact of RSV-LTRI may extend well beyond the acute phase of illness.

Despite the current pneumococcal vaccination program in England for older adults and adults with underlying conditions, disease burden remains high. We evaluated cost-effectiveness of 20-valent pne...

Despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) in England, disease burden among at-risk adults remains high. We evaluated the public health and budgetary impact of 20-valent p...