Cost effectiveness and public health impact of PCV20 among adults in France

Pneumococcal infections remain a significant public health concern in France, particularly among older adults at higher risk of developing severe forms. In 2023, the French health authorities updated vaccination guidelines recommending a single-dose 20-valent pneumococcal conjugate vaccine (PCV20) for adults at increased risk due to underlying medical conditions and later extending it to all adults aged 65 years and over. The objective of this analysis is first to evaluate the cost-effectiveness and public health impact of PCV20 in replacing 13-valent pneumococcal conjugate vaccine → 23-valent pneumococcal unconjugated polysaccharide vaccine (PCV13 → PPV23) in the vaccination programme and secondly to assess the value of extending the recommendation to a broader population.

A deterministic Markov model was adapted to compare clinical and economic outcomes of adult pneumococcal vaccination strategies in France over a lifetime horizon. The economic inputs in this analysis were estimated in 2024 euros from a healthcare system perspective. Population parameters, epidemiological data and cost were derived from French databases and institutional reports. Utility and vaccine effectiveness inputs were obtained from the literature.

Replacing PCV13 → PPV23 with PCV20 in at-risk adults reduced pneumococcal disease burden and was a dominant strategy, generating cost savings of €56,786 at the population level (€1.05 per patient) while improving health outcomes with an incremental gain of 0.00015 QALYs per patient. Expanding PCV20 to all individuals aged 65+ further reduced disease incidence and mortality over a lifetime horizon, averting 900 additional invasive pneumococcal diseases (IPD) cases (mainly bacteremia and meningitis), 11,600 pneumonia cases, and over 1,500 deaths. These additional health benefits were achieved at an incremental cost of €63,191 at population level (€0.81 per patient) corresponding to a gain of 0.00019 QALYs per patient. The incremental cost-effectiveness ratio was 4,308 €/QALY, indicating highly cost-effective strategy relative to commonly cited French vaccine HTA benchmarks.

PCV20 is a cost-saving alternative to the PCV13 → PPV23 sequence for at-risk adults in France. Expanding recommendations to include all adults aged 65 years and over provides substantial public health gains and represents a highly cost-effective strategy.