Cost-effectiveness of revised US pneumococcal vaccination recommendations in underserved minority adults < 65-years-old

Background: The 15-and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recently rec-ommended for US adults, giving either PCV20 alone or PCV15 followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) to all 65 +-year-olds and to high-risk younger adults. However, general population recommendations to vaccinate all 50-year-olds could reduce racial pneumococcal disease dis-parities given greater risk in underserved minority populations.Methods: A Markov model examining hypothetical 50-year-old Black cohorts (serving as a proxy for underserved minorities) and non-Black cohorts estimated the incremental cost effectiveness of US adult pneumococcal vaccination recommendations compared to PCV20 or PCV15/PPSV23 for all 50-year-olds with no vaccination thereafter, or PCV20 or PCV15/PPSV23 for all at ages 50 and 65 years (50/65). Model parameters came from US databases, clinical trials, and Delphi panels. Cohorts were followed over their lifetimes from a healthcare perspective discounted at 3 %/year.Results: PCV15/PPSV23 given at ages 50/65 had greatest public health impact. In Black cohorts, PCV15/ PPSV23 at age 50 cost $104,723/quality adjusted life year (QALY) gained compared to PCV20 at age 50, while PCV15/PPSV23 at 50/65 cost $240,952/QALY gained compared to PCV15/PPSV23 at age 50. Both current recommendation options were more expensive and less effective than other strategies in both cohorts. In sensitivity analyses, age-based PCV20 or PCV15/PPSV23 use at ages 50 or 50/65 could be favorable depending on vaccine effectiveness or differential vaccine uptake, while current recommenda-tions remained unfavorable.Conclusion: Recent risk-based US adult pneumococcal vaccination recommendations for adults < 65-ye ars-old, were economically and clinically unfavorable compared to general population vaccination of all 50-year-olds in Black and non-Black cohorts. An age-based pneumococcal vaccination recommenda-tion at age 50 years may reduce inequities in pneumococcal disease burden. (c) 2022 Elsevier Ltd. All rights reserved.