Abstract
BACKGROUND: In 2023, the US CDC recommended 20-valent pneumococcal conjugate vaccine (PCV20) or 15-valent pneumococcal conjugate vaccine (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65-years and older and those aged 19-64 years old with chronic conditions. However, there is substantial pneumococcal disease burden in healthy adults aged 50-64 years, particularly in Black adults, who are likely to benefit from vaccination. This study assesses the financial impact of introducing routine PCV15 or PCV20 in US adults aged 50-64 years. OBJECTIVE: To evaluate the budget impact of introducing PCV20 or PCV15/PPSV23 use in adults aged 50-64 years old compared to vaccinating only those with high-risk conditions for pneumococcal disease. METHODS: A budget impact model was developed over a 3-year time horizon to compare PCV20 versus PCV15/PPSV23 from the US payer perspective. Outcomes and costs of pneumococcal disease among US adults aged 50-64 years and those with underlying conditions were projected using a Markov decision model. RESULTS: Incorporating either PCV20 or PCV15/PPSV23 vaccines in routine vaccination programs for adults aged 50-64 years compared to vaccinating only adults with chronic conditions had an incremental budget impact of $6.5 and $9 billion, respectively, over three years. Budgetary impact was sensitive to number of vaccine doses, cost of vaccine per dose, vaccine coverage proportion and pneumococcal treatment cost across the overall population and sub-groups. Routine vaccination of 50-64-year-old age group was more economically favorable in Black adults sub-group analyses.