Dhwani Hariharan

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.

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 and Aims: Policymakers need data about the burden of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) among infants. This study estimates quality of life (QoL) for otherwise healthy term US infants with RSV‐LRTI and their caregivers, previously limited to premature and hospitalized infants, and corrects for selective testing.Methods: The study enrolled infants n = 11) LRTI‐tested infants (66.4) was lower than that in not‐tested LRTI infants (79.6,p = 0.096). For outpatient LRTI infants (n = 23), median QALYs/1000 losses were 9.8 and 0.25 for their caregivers. RSV‐positive outpatient LRTI infants (n = 6) had significantly milder QALYs/1000 losses (7.0) than other LRTI‐tested infants (n = 5)(21.8,p = 0.030). Visits earlier in the year were more likely to be RSV‐positive than later visits (p = 0.023). Modeled RSV‐positivity (51.9%) was lower than the observed rate (55.0%). Infants’ and caregivers’ QALYs/1000 loss were positively correlated (rho = 0.34,p = 0.046), indicating that infants perceived as sicker imposed greater burdens on caregivers.Conclusions: The overall median QALYs/1000 losses for LRTI (9.0) and RSV‐LRTI (5.6) in US infants are substantial, with additional losses for their caregivers (0.25 and 0.20, respectively). These losses extend equally to outpatient episodes. This study is the first reporting QALY losses for infants with LRTI born at term or presenting in nonhospitalized settings, and their caregivers.

Background: Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection in US children, reduces quality of life (QOL) of children, their caregivers, and families. Methods: We conducted a systematic literature review in PubMed, EconLit, and other databases in the United States of articles published since 2000, derived utility lost per RSV episode from cohort studies, and performed a systematic analysis. Results: From 2262 unique citations, 35 received full-text review and 7 met the inclusion criteria (2 cohort studies, 4 modeling studies, and 1 synthesis). Pooled data from the 2 cohort studies (both containing only hospitalized premature infants) gave quality-adjusted life-year (QALY) losses per episode of 0.0173 at day 38. From the cohort study that also assessed caregivers' QOL, we calculated net QALYs lost directly attributable to RSV per nonfatal episode from onset to 60 days after onset for the child, caregiver, child-and-caregiver dyad of 0.0169 (167% over prematurity alone), 0.0031, and 0.0200, respectively. Conclusion: Published data on QOL of children in the United States with RSV are scarce and consider only premature hospitalized infants, whereas most RSV episodes occur in children who were born at term and were otherwise healthy. QOL studies are needed beyond hospitalized premature infants.

Background: Limited data are available on the economic costs of respiratory syncytial virus (RSV) infections among infants and young children in the United States. Methods: We performed a systematic literature review of 10 key databases to identify studies published between 1 January 2014 and 2 August 2021 that reported RSV-related costs in US children aged 0–59 months. Costs were extracted and a systematic analysis was performed. Results: Seventeen studies were included. Although an RSV hospitalization (RSVH) of an extremely premature infant costs 5.6 times that of a full-term infant ($10 214), full-term infants accounted for 82% of RSVHs and 70% of RSVH costs. Medicaid-insured infants were 91% more likely than commercially insured infants to be hospitalized for RSV treatment in their first year of life. Medicaid financed 61% of infant RSVHs. Paying 32% less per hospitalization than commercial insurance, Medicaid paid 51% of infant RSVH costs. Infants’ RSV treatment costs $709.6 million annually, representing $187 per overall birth and $227 per publicly funded birth. Conclusions: Public sources pay for more than half of infants’ RSV medical costs, constituting the highest rate of RSVHs and the highest expenditure per birth. Full-term infants are the predominant source of infant RSVHs and costs.