Cost-effectiviveness of vaccination against pneumococcal bacteremia among elderly people: Results for belgium

Background: Several studies have shown that pneumococcal vaccination of old er persons would be cost-effective in preventing pneumococcal pneumonia, bu t evidence of clinical protection for this condition is uncertain. Given mu ch better evidence of vaccination effectiveness against invasive disease, s tudies showing that vaccination is cost-effective in preventing invasive di sease alone could provide strong support For public policies to vaccinate o lder persons. Methods: We examined the cost-effectiveness of preventing invasive pneumoco ccal infection by vaccination with the 23-valent pneumococcal polysaccharid e vaccine of persons greater than or equal to 65 years in age in Belgium. T he direct medical costs expressed per quality adjusted life year (QALYs) of a cohort of vaccinated persons was compared with the costs per QALY in a c ohort of persons who are not vaccinated. Results: Preventing invasive pneumococcal infections by vaccinating elderly persons clearly benefits people's health. By vaccinating 10,000 persons ov er 65 years of age, approximately eight QALYs can be gained compared with n o vaccination. Achieving these health benefits however requires additional costs,: 30,000 ECU per QALY gained. The cost-effectiveness ratio is slightl y better (i.e. 25,000 ECU per QALY) for the age group 65-75 years, and slig htly worse (i.e. 35,000 ECU per QALY) for the age group 75-84 years. It inc reases sharply to 77,000 ECU per QALY for the persons over 85 years of age. An extensive one-dimensional sensitivity analysis did not greatly affect t hese results. If vaccination is also clinically effective in preventing pneumococcal pneu monia, vaccinating all elderly persons is cost saving. Conclusion: Using empirical epidemiological data, pneumococcal vaccination to prevent invasive pneumococcal disease is acceptably to moderately cost-e ffective in Belgium. On the basis of our findings, we believe public health authorities should consider policies for encouraging pneumococcal vaccinat ion for all persons greater than or equal to 65 years in age.