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Giving 65 year olds PCV-13 pneumococcal vaccine not cost-effective

15 March, 2016

Research conducted at the HPRU in Immunisation reveals that giving 65 year olds PCV-13 pneumococcal vaccine is not cost-effective.

Administering healthy 65 year olds with the 13-valent conjugate pneumococcal vaccine (PCV-13) will not provide value for money and should not be introduced in England and Wales, according to new research published in the journal PLOS One.

Led by the London School of Hygiene & Tropical Medicine the study found the price of the vaccine had to drop below zero to be cost-effective. This was largely because cases of disease caused by the 13 vaccine types in that age group are already falling due to the indirect impact of the childhood vaccination programme. Vaccinating those aged 65 and over on top of children was projected to prevent less than 30 cases of invasive disease and less than 70 cases of hospitalised pneumonia out of a cohort of 442,435 65 year old.

The results of this study were key to last year’s decision by the Joint Committee of Vaccination and Immunisation not to offer PCV-13 to healthy 65 year olds. The research shows that the decision, which is in contrast with other countries like the USA where the vaccine has been introduced, might have cost the English tax payer up to £25 million a year.

Streptococcus pneumonia is a bacteria which is transmitted only from human to human, and which resides in the area behind the nose - the nasopharynx. Children are most frequently carrying the bacteria, and most of the times do not get sick or even show symptoms.  However occasionally the bacteria infects the ear (otitis media), lung (pneumonia) or finds its way into the blood stream (sepsis) or brain (meningitis).

On average, six to seven elderly people (aged 65+) in England and Wales will be hospitalised with a severe pneumococcal infection every day. There are over 90 different types known of which most are very rare and do not often cause disease. The types included in PCV-13 only cause around 15-20% of all invasive pneumococcus related disease among those 65 and over.

In a clinical trial in the Netherlands PCV-13 was able to prevent 75% of severe pneumococcal disease and 45% of pneumococcal pneumonia caused by the 13 bacterial types included in the vaccine. However, if introduced in the UK this vaccination programme would come on top of an existing childhood vaccination programme targeting the same 13-valent bacterial types. In England a fully immunised child already receives three doses of the pneumococcal vaccine at age two, four and 12-13 months.

An important step in the research was to estimate the number of future cases of disease as the impact of the childhood vaccination programme in the elderly is likely to expand over time. In England, a 7-valent childhood vaccine was introduced in 2006 which was replaced by the 13-valent vaccine in 2010. The researchers measured the indirect effect of the 7-serotype vaccine on disease linked to these seven serotypes in 65 and over, and then projected the impact of the additional six serotypes covered by the 13-valent vaccine.

Lead author Dr Albert Jan Van Hoek said: “Pneumonia is a serious problem among the elderly and it is important that we examine all options to prevent it. Unfortunately healthcare interventions can be extremely costly which means tough decisions often have to be made. The 13-valent pneumococcal vaccine only protects against a small sub-set of bacterial types, and the success of the childhood vaccination programme means fewer numbers of children are being infected with this sub-set. This means there is less chance for these to spread to the elderly. Therefore we have to keep looking for other vaccines or options to prevent pneumonia in the older population.”

As with modelled projections as used in the research, the reality might be different.  If the decline of the 13-valent types will not happen as projected, the researchers will revisit their models and conclusions.

The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England (PHE).



van Hoek AJ, Miller E (2016) Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England. PLoS ONE 11(2): e0149540. doi:10.1371/journal.pone.0149540


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