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Marbaix S, Mignon A, Taelman A, Averin A, Atwood M, Vietri J. Cost-utility of 20-valent pneumococcal conjugate vaccine compared to no vaccination and recommended alternative vaccines among Belgian adults. Expert Rev Vaccines 2023; 22:1008-1021. [PMID: 37872765 DOI: 10.1080/14760584.2023.2273892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population. RESEARCH DESIGN AND METHODS The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives. RESULTS Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65-84 years would also be cost-saving from the national healthcare perspective. CONCLUSION Based on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost.
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Affiliation(s)
- Sophie Marbaix
- Health Economics, SNB management, Soignies, Belgium
- Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons-UMONS, Mons, Belgium
| | | | | | - Ahuva Averin
- Health Economics, Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA
| | - Mark Atwood
- Health Economics, Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA
| | - Jeffrey Vietri
- Patient & Health Impact, Pfizer Inc, Collegeville, PA, USA
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Pneumococcal vaccination prevented severe LRTIs in adults: a causal inference framework applied in registry data. J Clin Epidemiol 2021; 143:118-127. [PMID: 34896235 DOI: 10.1016/j.jclinepi.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We estimated the effect of pneumococcal vaccination (PV) on acute lower respiratory tract infections (LRTIs) in various age and risk groups using different methods within a causal inference methodological framework. STUDY DESIGN AND SETTING We used data from a general practitioners' morbidity registry for the year 2019. Both traditional statistical methods (regression-based and propensity score methods) and machine learning techniques were deployed. Multiple imputation was used to account for missing data. Relative risks (RRs) with 95% confidence intervals were estimated. Sensitivity analyses were performed to account for the severity of LRTIs and differences in vaccination registration. RESULTS All methods showed a standardized mean difference below 0.1 for each covariate. No method was found to be superior to another. PV (combination of conjugate and polysaccharide vaccine) had an overall protective effect for severe LRTIs. PV was protective in different age and risk groups, especially in people aged 50-84 years with an intermediate risk group. CONCLUSION Using several techniques, PV was found to prevent severe LRTIs and confirmed the recommendations of the Belgian Superior Health Council.
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De Burghgraeve T, Henrard S, Verboven B, Van Pottelbergh G, Vaes B, Mathei C. The incidence of lower respiratory tract infections and pneumococcal vaccination status in adults in flemish primary care. Acta Clin Belg 2021; 76:335-345. [PMID: 32149595 DOI: 10.1080/17843286.2020.1735113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pneumococcal vaccination coverage of adults at risk for pneumococcal disease is below recommended levels. There is no observational data on pneumococcal vaccination and the incidence of lower respiratory tract infections in a general adult population. The current study had the objective to explore the incidence of lower respiratory tract infections and the pneumococcal vaccine coverage in function of age, influenza vaccination status and risk status, in Flanders, Belgium. We used data from Intego, ageneral practice-based morbidity registration network in Flanders (Belgium). We gathered data on pneumococcal vaccinations, influenza vaccination (in 2014) and ICPC2-coded diagnoses of pneumonia and acute bronchitis (2015). First, we divided the population into three groups along the risk status for developing apneumococcal infection according to the recommendations for pneumococcal vaccination in adults by the Belgian High Council of Health. 28.6% from our total adult study population are considered the target group for vaccination. Second, we found that the average pneumococcal vaccination coverage in this targeted population was 18.7%. Third, we found asignificantly higher incidence of LRTI in patients previously vaccinated against pneumococcal disease and/or influenza across the majority of subgroups. Pneumococcal vaccination coverage in Flanders is quantitatively low but observed to be qualitatively high in terms of reaching the most at risk population. Our findings are likely to be highly relevant to addressing future vaccination strategies in Flanders.
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Affiliation(s)
- Tine De Burghgraeve
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Séverine Henrard
- Louvain Drug Research Institute, Institut de Recherche Santé Et Société, Woluwe-Saint-Lambert, Belgium
| | - Bart Verboven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Catharina Mathei
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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O'Reilly R, Yokoyama S, Boyle J, Kwong JC, McGeer A, To T, Sander B. The impact of acute pneumococcal disease on health state utility values: a systematic review. Qual Life Res 2021; 31:375-388. [PMID: 34273067 DOI: 10.1007/s11136-021-02941-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Streptococcus pneumoniae infections remain a significant source of morbidity and mortality worldwide. The purpose of this review was to summarize the impact of pneumococcal disease on health state utilities (HSU) in the acute phase of illness. METHODS We searched MEDLINE, EMBASE, EconLit, the Health Technology Assessment Database, the National Health Economic Evaluation Database, and Tufts Cost-Effectiveness Registry (up to January 2020) for primary studies. Eligible studies elicited HSU estimates using preference-based instruments for the acute phase of infection of pneumococcal syndromes including acute otitis media, pneumonia/lower respiratory tract infections, bacteremia/sepsis, and meningitis. Two reviewers independently conducted screening, data extraction and quality appraisal. RESULTS We screened 10,178 studies, of which 26 met our inclusion criteria. Cohort sizes ranged from 8 to 2060 respondents. The most frequently studied syndrome was pneumonia (n = 17), followed by acute otitis media (n = 9), meningitis (n = 7) and bacteremia/sepsis (n = 4). Overall, each syndrome was associated with a substantial impact on HSU. Bacteremia/sepsis (range: - 0.331 to 0.992) and meningitis (range: - 0.330 to 0.977) were generally associated with the lowest HSU, followed by pneumonia (range: - 0.054 to 0.998) and acute otitis media (range: 0.064 to 0.970). HSU estimates varied considerably by treatment setting, elicitation method and type of respondent. The only study to compare pneumococcal infections to non-pneumococcal infections in the same population revealed significantly lower HSU estimates among pneumococcal infections. CONCLUSIONS Pneumococcal syndromes are associated with decreased HSU estimates. Given the considerable heterogeneity in methods and source populations as well as study quality, care should be taken to select the most appropriate estimates.
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Affiliation(s)
- Ryan O'Reilly
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada. .,, 200 Elizabeth Avenue, Eaton Building, Room 10-248, Toronto, ON, M5G 2C4, Canada.
| | - Sayako Yokoyama
- Public Health Ontario, Toronto, ON, Canada.,University of Waterloo, Waterloo, ON, Canada
| | - Justin Boyle
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Vaccine-Preventable Diseases, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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Gamma-irradiation of Streptococcus pneumoniae for the use as an immunogenic whole cell vaccine. J Microbiol 2018; 56:579-585. [PMID: 30047087 DOI: 10.1007/s12275-018-8347-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
Streptococcus pneumoniae is a major respiratory pathogen that causes millions of deaths worldwide. Although subunit vaccines formulated with the capsular polysaccharides or their protein conjugates are currently-available, low-cost vaccines with wide serotype coverage still remain to be developed, especially for developing countries. Recently, gamma- irradiation has been considered as an effective inactivation method to prepare S. pneumoniae vaccine candidate. In this study, we investigated the immunogenicity and protective immunity of gamma-irradiated S. pneumoniae (r-SP), by comparing with heat-inactivated S. pneumoniae (h-SP) and formalin-inactivated S. pneumoniae (f-SP), both of which were made by traditional inactivation methods. Intranasal immunization of C57BL/6 mice with r-SP in combination with cholera toxin as an adjuvant enhanced S. pneumoniaespecific antibodies on the airway mucosal surface and in sera more potently than that with h-SP or f-SP under the same conditions. In addition, sera from mice immunized with r-SP potently induced opsonophagocytic killing activity more effectively than those of h-SP or f-SP, implying that r-SP could induce protective antibodies. Above all, immunization with r-SP effectively protected mice against S. pneumoniae infection. Collectively, these results suggest that gamma- irradiation is an effective method for the development of a killed whole cell pneumococcal vaccine that elicits robust mucosal and systemic immune responses.
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Protasov AD, Zhestkov AV, Kostinov MP, Shteiner ML, Tezikov YV, Lipatov IS, Yastrebova NE, Kostinova AM, Ryzhov AA, Polishchuk VB. [Analysis of the effectiveness and long-term results of formation of adaptive immunity in the use of various medications and vaccination schemes against pneumococcal infection in patients with chronic obstructive pulmonary disease]. TERAPEVT ARKH 2018; 89:165-174. [PMID: 29488477 DOI: 10.17116/terarkh20178912165-174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the long-term clinical results of vaccination with pneumococcal polysaccharide and conjugated polysaccharide vaccines in the separate and sequential use, by determining the optimal vaccination schedule in adult patients with chronic obstructive pulmonary disease (COPD) and to investigate adaptive immunity levels. SUBJECTS AND METHODS The clinical effects of vaccination were evaluated in patients with COPD within 1 and 4 years after immunization against pneumococcal infection using various schemes, as well as the time course of changes in adaptive immunity indicators was examined. RESULTS Four years after vaccination, the 13-valent pneumococcal conjugate vaccine (PCV13)/23-valent pneumococcal polysaccharide vaccine (PPV23) group showed a decline in the number of patients with COPD exacerbations by 50% (p<0.001) and reductions in the number of antimicrobial chemotherapy cycles by 47.8% (p<0.001) and in that of hospitalizations by 87.5% (p<0.001). At 1 year after vaccination versus at baseline, the COPD patients vaccinated against pneumococcal disease, regardless of the drug and schedule of vaccination, displayed elevated levels of IgG antibodies to the mixture of capsular polysaccharides included in PPV23 and PCV13. CONCLUSION It has been indicated that a complex of basic therapy for patients with COPD should include initial vaccination with PCV13, followed by administration of a booster dose of PPV23.
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Affiliation(s)
- A D Protasov
- Samara State Medical University, Ministry of Health of Russia, Samara, Russia
| | - A V Zhestkov
- Samara State Medical University, Ministry of Health of Russia, Samara, Russia
| | - M P Kostinov
- I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - M L Shteiner
- Samara State Medical University, Ministry of Health of Russia, Samara, Russia
| | - Yu V Tezikov
- Samara State Medical University, Ministry of Health of Russia, Samara, Russia
| | - I S Lipatov
- Samara State Medical University, Ministry of Health of Russia, Samara, Russia
| | - N E Yastrebova
- I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - A M Kostinova
- I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - A A Ryzhov
- I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - V B Polishchuk
- I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
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Flamaing J, De Backer W, Van Laethem Y, Heijmans S, Mignon A. Erratum to: Pneumococcal lower respiratory tract infections in adults: an observational case-control study in primary care in Belgium. BMC FAMILY PRACTICE 2016; 17:25. [PMID: 26936072 PMCID: PMC4776432 DOI: 10.1186/s12875-016-0420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Johan Flamaing
- Department of Geriatric Medicine, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium. .,Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Wilfried De Backer
- Department of Pulmonary Medicine, University Hospital and University of Antwerp, 10 Wilrijkstraat, B-2650, Edegem, Belgium
| | - Yves Van Laethem
- Department of Infectiology, University Hospital Saint-Pierre, 322 Rue Haute, B-1000, Brussels, Belgium
| | - Stéphane Heijmans
- Clinical Research Network, Researchlink, 78 Stationstraat, B-1630, Linkebeek, Belgium
| | - Annick Mignon
- Medical Affairs, Pfizer Vaccines, 17 Boulevard de la Plaine, B-1050, Brussels, Belgium
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