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Recalibrated estimates of non-bacteremic and bacteremic pneumococcal community acquired pneumonia in hospitalized Canadian adults from 2010 to 2017 with addition of an extended spectrum serotype-specific urine antigen detection assay. Vaccine 2022; 40:2635-2646. [DOI: 10.1016/j.vaccine.2022.02.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
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Igarashi A, Hirose E, Kobayashi Y, Yonemoto N, Lee B. Cost-effectiveness analysis for PCV13 in adults 60 years and over with underlying medical conditions which put them at an elevated risk of pneumococcal disease in Japan. Expert Rev Vaccines 2021; 20:1153-1165. [PMID: 34259118 DOI: 10.1080/14760584.2021.1952869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: The objective of this study was to conduct a cost-effectiveness analysis of PCV13 vs. PPV23 and no vaccination and PPV23 vs. no vaccination in adults aged ≥ 60 years with underlying medical conditions which put them at an elevated risk of pneumococcal disease in a Japanese healthcare setting.Research design and methods: A natural history model was developed with a life-long time horizon and 1-year cycle length, with microsimulation as a modeling technique. The expected costs from a public payer's and societal perspective, quality-adjusted life-years (QALYs), and prevented cases and deaths caused by IPD (invasive pneumococcal disease) and NBP (non-bacteremic pneumococcal pneumonia) were estimated.Results: In the base-case scenario, the cost per QALY gained from a public payer's perspective for PCV13 vs, PPV23 and no vaccination were 500,255JPY and 1,139,438JPY, respectively, The cost per QALY gained for PPV23 vs no vaccination was 1,687,057JPY. Over the life-long time horizon for 1 million patients, when compared to PPV23, PCV13 resulted in 65 fewer IPD cases, 2,894 fewer NBP cases, and 384 fewer deaths caused by pneumococcal disease.Conclusions: In adults aged 60 years and over with underlying medical conditions, PCV13 was shown to be a more cost-effective alternative to PPV23.
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Affiliation(s)
- Ataru Igarashi
- Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan.,Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo, Japan
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Sun X, Tang Y, Ma X, Guo X, Huang Z, Ren J, Qiu J, Jiang H, Lu Y. Cost-Effectiveness Analysis of 23-Valent Pneumococcal Polysaccharide Vaccine Program for the Elderly Aged 60 Years or Older in Shanghai, China. Front Public Health 2021; 9:647725. [PMID: 34109145 PMCID: PMC8181136 DOI: 10.3389/fpubh.2021.647725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pneumococcal vaccine has been considered as the most effective measure to prevent pneumococcal diseases. In 2013, Shanghai launched a major public health program to vaccinate people aged 60 years or older with 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV-23) free of charge. By the end of June 2020, a total of 1.56 million old people had been vaccinated free of charge. Objective: To evaluate the cost-effectiveness of PPSV-23 vaccination program in Shanghai from the health system perspective. Methods: According to the actual number of people aged 60 years or older with PPSV-23 vaccination in Shanghai from 2013 to 2018, a multi-cohort Markov model for life-time was developed to compare health and economic outcomes of vaccinated people vs. if they were not vaccinated for PPSV-23. Cost effectiveness was reported as incremental cost effectiveness ratio (ICER). A 5% discount rate was used for both costs and health outcomes. In addition, one-way sensitivity analysis was used to test the model's robustness. Results: By the end of 2018, a total of 1,091,967 people aged 60 years or older were vaccinated with PPSV-23 in Shanghai, China. Comparing with the unvaccinated circumstances, PPSV-23 vaccination would cost US $19.62 million more and receive an additional 10,321.3 quality-adjusted life-year (QALY). PPSV-23 was associated with the ICER of $190.1 per QALY gained. The Results were sensitive to the variation of vaccine effectiveness against community-acquired pneumonia (CAP), and disease incidence, mortality, and costs of CAP. In all sensitivity analysis, the PPSV-23 was economical. Conclusion: The PPSV-23 vaccination program in Shanghai was cost-effective. With the further development of the project, the administrative costs of the vaccine will be reduced, making it more cost-effective.
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Affiliation(s)
- Xiaodong Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yuekun Tang
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaoying Ma
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiang Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zhuoying Huang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jia Ren
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jing Qiu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hongli Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Yihan Lu
- School of Public Health, Fudan University, Shanghai, China
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Samuel M, Tardif JC, Khairy P, Roubille F, Waters DD, Grégoire JC, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Ostadal P, Lopez-Sendon J, Gamra H, Kiwan GS, Dubé MP, Provencher M, Orfanos A, Blondeau L, Kouz S, L'Allier PL, Ibrahim R, Bouabdallaoui N, Mitchell D, Guertin MC, Lelorier J. Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:486-495. [PMID: 32407460 PMCID: PMC8445085 DOI: 10.1093/ehjqcco/qcaa045] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022]
Abstract
Aims In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy. Methods and results A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy. Conclusion Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
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Affiliation(s)
- Michelle Samuel
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - François Roubille
- Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France
| | - David D Waters
- San Francisco General Hospital, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Fausto J Pinto
- Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Aldo P Maggioni
- ANMCO Research Center, Via La Marmora 34, 50121 Firenze, Italy
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Paraguay 160, 2000, Rosario, Argentina
| | - Colin Berry
- University of Glasgow and NHS Glasgow Clinical Research Facility, 126 University Pl, University of Glasgow, Glasgow, G12 8TA, Scotland, UK
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Lazarettstr. 36, D-80636 Munchen, Germany
| | - Petr Ostadal
- Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 150 00 Prague, Czech Republic
| | - Jose Lopez-Sendon
- H La Paz, IdiPaz, UAM, Ciber-CV Madrid, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - Ghassan S Kiwan
- Bellevue Medical Center, Qanater Zubayda- Mansouriyeh, Mansourieh, Metn District, Beirut, Lebanon
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Mylène Provencher
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Andreas Orfanos
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Lucie Blondeau
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, 1000 Sainte-Anne Blvd Saint-Charles-Borromée, Quebec J6E 6J2, Canada
| | - Philippe L L'Allier
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
| | - Dominic Mitchell
- Logimetrix Inc., 3600 Rhodes Drive Windsor, Ontario N8W 5A4, Canada
| | - Marie-Claude Guertin
- The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
| | - Jacques Lelorier
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St Montreal, Quebec H2X 0A9, Canada
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Wilson MR, Wasserman MD, Breton MC, Peloquin F, Earnshaw SR, McDade C, Sings HL, Farkouh RA. Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis. Infect Dis Ther 2020; 9:341-353. [PMID: 32270372 PMCID: PMC7237628 DOI: 10.1007/s40121-020-00294-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/26/2022] Open
Abstract
Objective A model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively. Methods Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use. Results PCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM. Conclusions Canadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs. Electronic supplementary material The online version of this article (10.1007/s40121-020-00294-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Cheryl McDade
- RTI Health Solutions, Research Triangle Park, NC, USA
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LeBlanc J, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang AL, Gillis HD, Martin I, Demczuk WH, LaFerriere C, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil SA. Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015. BMJ Open Respir Res 2020; 7:e000550. [PMID: 32188585 PMCID: PMC7078693 DOI: 10.1136/bmjresp-2019-000550] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age. METHODS Surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16-49, 50-64, ≥65 and ≥50 years). RESULTS Of 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively. CONCLUSIONS Adults hospitalised with pCAP in the age cohort of 50-64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.
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Affiliation(s)
- Jason LeBlanc
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda Ls Lang
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irene Martin
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Walter H Demczuk
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | | | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - William Bowie
- Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Green
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Department of Medicine, Public Health Ontario and University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne McCarthy
- Division of Infectious Diseases, Ottawa Hospital General Campus and University of Ottawa, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Makeda Semret
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Trottier
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectiology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Duncan Webster
- Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Shami JJP, Pathadka S, Chan EW, Hui J, Sato R, Patil S, Li X. Evaluating the cost-effectiveness of a sequential pneumococcal vaccination compared to single-dose vaccination strategy for adults in Hong Kong. Hum Vaccin Immunother 2020; 16:1937-1944. [PMID: 31977268 DOI: 10.1080/21645515.2019.1711300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Two vaccines, 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), are widely available for the prevention of pneumococcal disease in adults. However, it is unclear how cost-effective these pneumococcal vaccine choices are in the Hong Kong healthcare environment. We aimed to assess the cost-effectiveness of a sequential administration of PCV13 followed by PPSV23 compared to a single dose of PPSV23 vaccination for pneumococcal disease control in Hong Kong adults aged ≥65 years and individuals aged 20-64 years with immunocompromising and chronic conditions. A previously developed deterministic cohort sequential model was applied to compare the outcomes of two vaccination strategies from a societal perspective. Population-specific model input, including incidence, mortality, case-fatality, risk group distribution, vaccination costs, disease management, and productivity loss, was estimated from a Hong Kong-wide electronic medical database. Costs were valued in US$ in 2017. Vaccination strategies with an incremental cost-effectiveness ratio (ICER, defined as incremental cost per QALY saved) less than one local GDP per capita ($46,193 in 2017) were defined as highly cost-effective. Deterministic sensitivity analyses (SA) were conducted. Compared with single-dose PPSV23, sequential vaccination of PCV13 followed by PPSV23 was cost-saving for adults aged ≥20 years. In the deterministic SA, the base-case results were robust for tested parameter uncertainties. Future vaccination policies should consider the cost-effectiveness of a sequential vaccination strategy as a measure to reduce the vaccine-preventable pneumococcal disease burden in Hong Kong.
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Affiliation(s)
- Jessica J P Shami
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong Special Administrative Region, Hong Kong, China
| | - Swathi Pathadka
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong Special Administrative Region, Hong Kong, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong Special Administrative Region, Hong Kong, China
| | | | | | | | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong Special Administrative Region, Hong Kong, China
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Kaplan A, Arsenault P, Aw B, Brown V, Fox G, Grossman R, Jadavji T, Laferrière C, Levitz S, Loeb M, McIvor A, Mody CH, Poulin Y, Shapiro M, Tessier D, Théorêt F, Weiss K, Yaremko J, Zhanel G. Vaccine strategies for prevention of community-acquired pneumonia in Canada: Who would benefit most from pneumococcal immunization? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:625-633. [PMID: 31515311 PMCID: PMC6741809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the burden of pneumococcal disease and associated risk factors in the Canadian adult population, delineate available pneumococcal vaccines and associated efficacy and effectiveness data, and review current pneumococcal vaccine recommendations and community-acquired pneumonia (CAP) prevention strategies in Canada. QUALITY OF EVIDENCE Pneumococcal vaccination guidelines from the Canadian National Advisory Committee on Immunization in 2013 and 2016 constitute level III evidence for CAP prevention in the Canadian adult population. MAIN MESSAGE It is recommended that immunosuppressed adults of all ages receive the 13-valent pneumococcal conjugate vaccine (PCV13) (grades A and B recommendations). In 2016, the National Advisory Committee on Immunization also recommended that all adults aged 65 years and older receive PCV13 (grade A recommendation) on an individual basis, followed by the 23-valent pneumococcal polysaccharide vaccine (grade B recommendation). This update is based on a large clinical study that demonstrated PCV13 efficacy against vaccine-type CAP in this population. CONCLUSION Physicians should focus on improving pneumococcal vaccination rates among adults, which remain low. Vaccination with PCV13 should also be considered for adults with chronic conditions, whose baseline risk is often higher than that for healthy individuals aged 65 years and older.
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Affiliation(s)
- Alan Kaplan
- Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario.
| | - Pierre Arsenault
- Associate Professor in the Department of Family and Emergency Medicine at the University of Sherbrooke in Quebec
| | - Brian Aw
- Family physician at the Ultimate Health Medical Centre in Richmond Hill, Ont
| | - Vivien Brown
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
| | - George Fox
- Professor in the Department of Medicine (Respirology) at Memorial University of Newfoundland in St John's
| | - Ron Grossman
- Professor in the Department of Medicine at the University of Toronto
| | - Taj Jadavji
- Professor in the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary in Alberta
| | - Craig Laferrière
- Regional Medical Research Specialist and Medical Advisor with Pfizer Canada Inc in Kirkland, Que, at the time of writing
| | - Suzanne Levitz
- Assistant Professor in the Department of Family Medicine at McGill University in Montreal, Que
| | - Mark Loeb
- Professor in the Department of Pathology and Molecular Medicine at McMaster University in Hamilton, Ont
| | - Andrew McIvor
- Professor in the Division of Respirology in the Department of Medicine at McMaster University
| | - Christopher H Mody
- Professor and Head of the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary
| | - Yannick Poulin
- Assistant Professor in the Department of Medicine at the University of Sherbrooke
| | - Marla Shapiro
- Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Dominique Tessier
- Clinician at the Hôpital Saint-Luc du CHUM in the Groupe de médecine de famille du Quartier Latin and Medical Director of the Groupe Santé Voyage in Montreal
| | - Francois Théorêt
- Family physician on the Lower Outaouais Family Health Team in Hawkesbury, Ont
| | - Karl Weiss
- Chief of the Division of Infectious Diseases at the Jewish General Hospital of McGill University
| | - John Yaremko
- Assistant Professor in the Department of Pediatrics and the Department of Family Medicine at McGill University
| | - George Zhanel
- Professor in the Department of Medical Microbiology and Infectious Diseases at the University of Manitoba in Winnipeg
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9
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López-Gobernado M, Pérez-Rubio A, López-García E, Mayo Iscar A, Cabezas Pascual C, Eiros JM. [Economic evaluation of pneumococcal vaccination in adults aged over 65 years in Castilla y León (SPAIN)]. Rev Esp Geriatr Gerontol 2019; 54:309-314. [PMID: 31307781 DOI: 10.1016/j.regg.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/01/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The burden of disease due to pneumonia in older adults has a major impact on health systems. The aim of this study is to carry out an economic evaluation of the vaccination strategy against Streptococcus pneumoniae using the 13-valent pneumococcal conjugate vaccine. MATERIAL AND METHODS A simulated economic model has been developed in the form of a decision tree to evaluate the cost of the vaccination strategy in the population over 65 years of the Valladolid-East Health Area, versus non-vaccination, using a Monte Carlo probabilistic analysis. RESULTS Streptococcus pneumoniae annually generates 557.24 cases of pneumococcal disease in the Valladolid-East Health Area, and 506.60 episodes have pneumonia symptoms. Vaccination of the cohort over 65 years of age is an efficient measure from the third year, with a cost per quality-adjusted life years (QALY) of 20,496.20 €. The number of QALYs gained in a decade is 86.07 and an amount of 216.252.89 € with this vaccination strategy would be saved. CONCLUSIONS The evaluation of the different incremental costs (QALY,euros) in the years of follow-up, the pneumococcus vaccination program in people over 65 in Castilla y León is cost-effective.
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Affiliation(s)
- Miguel López-Gobernado
- Servicio de Estudios, Documentación y Estadística, Consejería de Sanidad de la Junta de Castilla y León, Valladolid, España.
| | - Alberto Pérez-Rubio
- Dirección Médica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Eva López-García
- Coordinación de equipos, Gerencia de Atención Primaria Valladolid Oeste, Valladolid, España
| | | | | | - Jose María Eiros
- Facultad de Medicina, Universidad de Valladolid, Valladolid, España; Servicio de Microbiología, Hospital Universitario Río Hortega, Valladolid, España
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