Economic evaluations of adult pneumococcal vaccination strategies

We performed an extensive search for full economic evaluations on pneumococcal vaccination in adults. We included 11 North American and 9 European studies for review. There was a clear preference for cost-effectiveness and cost-utility versus cost-benefit analysis. In general, pneumococcal vaccination of the elderly <75 years and of particular risk groups is found to be relatively cost-effective and potentially cost-saving to the health care sector and to society. However, there is substantial uncertainty about the effectiveness of the intervention in these target groups. From 1997 on most analysts have taken this partly into account by distinguishing between invasive and non-invasive pneumococcal disease. In order to be relevant, future analyses should use quality adjusted life-years, adapt life-expectancy for people at risk of infection, narrow the targeted age groups, include realistic programme costs and discuss the potential influence of unrelated future costs. Finally, estimating the impact of antimicrobial resistance (not included in any of the analyses) seems particularly challenging for the future.