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Medical Decision Making
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Cost-Effectiveness of the Pneumococcal Vaccine in Healthy Younger Adults

Patricia Vold Pepper, MD, MSc

Department of Internal Medicine, Naval Medical Center San Diego, CA pvpepper{at}nmcsd.med.navy.mil

Douglas K. Owens, MD, MS

VA Health Care System, Palo Alto, CA, Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Stanford, CA

Objectives. Routine vaccination for Streptococcus pneumoniae has been recommended as a cost-effective measure for elderly and immunocompromised patients, yet no analysis has been performed for healthy younger adults in America. The authors evaluated the cost-effectiveness of the pneumococcal vaccine and determined the net health benefits conferred for the healthy young adult population. Methods.The authors developed a decision model to compare the health and economic outcomes of vaccinate versus do not vaccinate for S. pneumoniae. Results.Vaccinating patients for S. pneumoniae generates benefits that are dependent on incidence rates and the efficacyof the vaccine. In the 22-year-old patient with a pneumonia incidence of 0.3/1000, the vaccine would need to be >71 percent effective for the vaccination strategy to cost less than $50,000/QALY gained. At an incidence of 0.4/1000, the threshold efficacy is 53 percent, whereas at 0.5/1000 it is 43 percent. In the 35-year-old patient where the incidence of pneumococcal pneumonia is higher (0.85/1000), the vaccine would be cost-effective with an efficacy as low as 30 percent. Conclusions.Use of the S. pneumoniae vaccine in young adults would provide modest reductions in pneumonia-associated morbidity and mortality. Vaccination of young adults is moderately expensive unless vaccine efficacy is above 50% to 60%. In 35-year-old adults, use of the vaccine is cost-effective even with moderate efficacy.

Key Words: cost-effectiveness • pneumococcal vaccine • healthy young adults

Medical Decision Making, Vol. 22, No. 5 suppl, S45-S57 (2002)
DOI: 10.1177/027298902237705
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