Infectious Disease · Pediatrics · Public Health ·
Dutch model finds infant PCV20 strategy costly versus PCV15
A population-based Markov model compared infant PCV20 and PCV15 strategies in the Netherlands over 10 years, accounting for indirect effects and adult vaccination. Replacing PCV15 (2 + 1) with PCV20 (3 + 1) was associated with 3,476 fewer QALYs and €192 million in additional costs when adults received PCV20.
- Model projected 3,476 fewer QALYs with infant PCV20 (3 + 1).
- The strategy added €192 million in modeled costs.
- Results depended on indirect-effect and vaccine-cost assumptions.
Researchers used a static, population-based Markov model to compare pneumococcal vaccination strategies in the Netherlands over 10 years. The model estimated societal costs and quality-adjusted life-year (QALY) losses from invasive pneumococcal disease and hospitalized non-invasive pneumococcal pneumonia. Projections incorporated indirect protection and serotype replacement, and assumed PCV20 uptake of 55–70% among adults aged 60 years or older.
Replacing infant PCV15 (2 + 1) with PCV20 (3 + 1) produced QALY gains in children and adults younger than 60, but later losses among older adults as disease shifted to non-PCV20 serotypes. Across the population, the change resulted in 3,476 fewer QALYs and €192 million in additional costs; PCV15 was the dominant strategy. In a scenario comparing infant PCV20 with PCV15 (both 3 + 1) alongside adult PCV21, there was no net QALY loss, but the incremental cost-effectiveness ratio was €304,781 per QALY gained, above the stated Dutch thresholds of €20,000–€50,000.
The findings are model-based, not observed clinical outcomes, and were sensitive to assumptions about indirect effects, time horizon, and vaccine costs. The study was funded by the Netherlands Ministry of Health, Welfare and Sport; authors reported no competing interests.
In practice
For Dutch immunization-policy decisions, the model suggests that replacing infant PCV15 (2 + 1) with PCV20 (3 + 1) while using PCV20 in older adults could reduce modeled population health over 10 years, despite gains in children and adults younger than 60. A PCV21 adult-vaccination scenario avoided net QALY loss but remained above the stated Dutch cost-effectiveness thresholds. These are projections rather than observed outcomes and are sensitive to assumptions about indirect effects, time horizon, and vaccine costs; they do not establish a clinical benefit or harm for an individual child.
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BMC Medicine: Cost-effectiveness of 20-valent versus 15-valent pneumococcal conjugate vaccines for infants in the Netherlands, taking into account indirect effects and adult vaccination ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.