Cost-effectiveness analysis of pneumococcal vaccination of adults and elderly persons in Belgium

Objective: To analyse the direct medical costs and effectiveness of vaccina ting adults aged between 18 and 64 years and elderly persons greater than o r equal to 65 years of age with the 23-valent pneumococcal polysaccharide v accine. Design and setting: This was a decision-analytic modelling study fr om the societal perspective in Belgium. The analysis compared 'vaccination' with 'no vaccination and treatment'. Methods: Calculations were based on the assumption that vaccination is as e ffective against all pneumococcal infections as it is against invasive pneu mococcal disease. Data on the incidence of pneumococcal pneumonia and menin gitis, frequency of hospitalisation, mortality rates and vaccine effectiven ess were derived from the international literature. Costs were derived from analysis of historical data for cases of pneumococcal infection in Belgium . Results: Vaccinating 1000 adults between the ages of 18 and 64 years gains approximately 2 life-years in comparison with the no vaccination option. Ho w ever, to realise these additional health benefits requires additional cos ts of 11 800 European Currency Units (ECU; 1995 values) per life-year saved . Vaccinating 1000 elderly people (greater than or equal to 65 years) leads to >9 life-years gained as well as a small monetary benefit of ECU1250. An extensive sensitivity analysis did not greatly affect the results for the elderly population: vaccination in this age group always remained favourabl e, and thus it is clearly indicated from an economic point of view. A cruci al assumption for both age groups is that the effectiveness of the vaccine holds for all pneumococcal pneumonia. It is clear that the results will bec ome less favourable if this assumption is dropped. Conclusions: Preventing pneumococcal infections by vaccination clearly bene fits people's health. Reimbursement can be recommended for the elderly grou p; however more accurate epidemiological data are still needed to make deci sions concerning routine pneumococcal vaccination in adults <65 years of ag e. Unfortunately, the issue of whether the effectiveness of the vaccine hol ds for all pneumococcal pneumonia is as yet unresolved in the medical liter ature.