1439. The Cost-Effectiveness of Vaccinating Adults at Increased Risk of Pneumococcal Disease Against Pneumococcal Disease in The Netherlands

BACKGROUND: There is currently no data on the age- and risk-group-specific cost-effectiveness of the 13 valent pneumococcal vaccine (PCV13) compared with the 23 valent polysaccharide vaccine (PPV23). The aim of this study was to evaluate the cost-effectiveness of vaccinating these specific groups against pneumococcal disease. METHODS: A previously published and independently validated (by The Dutch National Health-Care Institute) age-and risk-group-specific Markov-type model was used to compare the cost-effectiveness of PCV13 vaccination vs. PPV23 vaccination of all adults at increased risk of pneumococcal disease (i.e., adults with underlying disease and those ≥50 years). Efficacy estimates for PCV13 were extrapolated from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Efficacy estimates for PPV23 were based on systematic literature reviews and other published data. RESULTS: At list price (€68.56 for PCV13 and €19.99 for PPV23), vaccination of all adults at increased risk of pneumococcal disease resulted in an ICER of €20,186/QALY, while vaccinating those with chronic medical conditions (moderate risk) and immunocompromising conditions (high risk) resulted in an ICER of <€10,000/QALY. Large differences in ICERs between age-and risk-groups were observed(table). Vaccinating, high-risk individuals with PCV13 was cost-saving for those aged less than 65 years of age compared with PPV23 while vaccinating those aged 85 years and older with PCV13 was moderate cost-effective with an ICER of €60,900/QALY. Vaccinating moderate risk individuals was highly cost-effective (<€20,000/QALY), while vaccinating those with low-risk of pneumococcal infection was cost-effective (<€50,000/QALY). However, within risk groups the ICER differed significantly between age groups. Sensitivity analysis showed that a proportional decrease in list price, such as common in national vaccination programs, decreased the ICER disproportionally in favor of PCV13. CONCLUSION: Vaccination all adults with PCV13 is cost effective compared with PPV23. There is a large variation in the cost-effectiveness between age and risk groups. Targeting individuals with underlying diseases aged less than 85 years would provide most value for money. [Image: see text] DISCLOSURES: M. Rozenbaum, Pfizer: Employee and Shareholder, Salary.