Delta price cost-effectiveness analysis of PCV21 vs PCV20 use in adults aged ≥65 years in Switzerland

This study evaluated the health and economic impacts of the 21-valent pneumococcal conjugate vaccine (PCV21) compared to the 20-valent pneumococcal conjugate vaccine (PCV20) in Swiss adults aged 65 years and older using the delta-price approach.

A published state-transition Markov model was used to track health and economic outcomes of invasive pneumococcal disease (IPD), inpatient non-bacteremic pneumococcal pneumonia (NBPP), and post-meningitis sequelae (PMS). Estimated quality-adjusted life years (QALYs)and cost outcomes were discounted at 3%. All costs were presented in 2024 Swiss Franc (CHF). Price premiums were estimated as the difference between the prices of PCV21 and PCV20, and the maximum premiums at which PCV21 remains cost-saving and cost-effective (at a willingness-to-pay threshold of CHF 40,000) were reported. A scenario analysis was conducted to include a pneumococcal polysaccharide vaccine 23-valent (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) vaccine-experienced population. Sensitivity analysis identified the input categories that were most influential on the price premiums.

Overall, PCV21 averted more cases of IPD, NBPP, PMS and associated deaths, and saved more direct costs than PCV20. Compared to PCV20, PCV21 was cost-saving until a price premium of CHF 25.10 and cost-effective up to a price premium of CHF 88.01. In the scenario analysis, PCV21 was cost-saving up to a price premium of CHF 25.38, and cost-effective up to a price premium of CHF 88.68. Vaccine effectiveness and disease costs were the most influential inputs on the price premiums.

PCV21 provides greater health and economic benefits than PCV20 and is cost-effective over a range of price premiums.