Cost-Effectiveness Analysis of 23-Valent Pneumococcal Polysaccharide Vaccine Program for the Elderly Aged 60 Years or Older in Shanghai, China

Closer adult child-parent relations the stronger the vaccine hesitancy: A cross-sectional study of adult Children's attitudes toward pneumococcal vaccination of elderly parents and its determinants in Guangzhou, China

Pneumococcal disease (PD) has a serious effect on older people aged 60 years and above. However, pneumococcal vaccination rates for older people in China remain low. This study aimed to explore adult children's perspectives on the vaccination of their parents and to examine the determinants of vaccine hesitancy. In October 2022, a cross-sectional survey was conducted in Guangzhou, China. The questionnaire assesses data on the sociodemographic characteristics of adult children and their parents, health beliefs about vaccination, and variables measuring adult child-parent relationships. Adult child-parent relationships types were identified by Latent Class Analysis (LCA). Binary logistic regression was employed to examine the factors associated with vaccine hesitancy. A total of 1,597 respondents were enrolled in the study, and 59.8% of the adult children expressed hesitancy about vaccinating their elderly parents. The LCA model identified three distinct types of adult child-parent relations: detached, intimate but distant, and tight-knit. Binary logistic regression analyses revealed that respondents with intimate but distant (OR = 3.04) and tight-knit (OR = 3.01) adult child - parent relationships, high literacy (OR = 2.63), and high perceived barriers of vaccine (OR = 1.18) were more likely to be hesitant. Conversely, those with high income (OR = 0.35) and parents with difficulties in activities of daily living (OR = 0.44) were less likely to exhibit vaccine hesitancy. Close adult child-parent relations were positively associated with vaccine hesitancy. Health education related to the vaccination of older persons should be extended to adult children.

A narrative review on the effectiveness of PPSV23 vaccination in adults in China

Pneumococcal Polysaccharide Vaccine (PPSV23) is available for free in some Chinese cities for elderly patients and those with comorbidities. However, there is a lack of studies summarizing its preventive effect specifically in Chinese adults. This review aims to discuss the epidemiology of pneumococcal disease, coverage and effectiveness of PPSV23 vaccination, elderly individuals and patients with comorbidities, coadministration of PPSV23 vaccine with other vaccines, and future directions for its use in China. It was found that the PPSV23 vaccination rate among the elderly ranged from 1.2% to 42.1% depending on location, with an effectiveness of 9.34%(95%CI: 2.05%, 16.62%) to 57.7%(95%CI: 20.7%, 77.5%). There is a need to raise awareness of pneumococcal disease and its prevention, especially in China. To better manage pneumococcal disease in China, developing new vaccines for common serotypes and continuously monitoring serotype distribution associated with the disease is also needed.

Cost-effectiveness analysis of herpes zoster vaccination for adults aged 50 years in Zhejiang province, China

Objective

Live-attenuated zoster vaccine (LZV) and adjuvanted recombinant zoster vaccine (RZV) have been approved for use in China. This study aimed to evaluate and compare the cost-effectiveness of these two herpes zoster (HZ) vaccination strategies in a birth cohort of individuals aged 50 years.

Methods

The cost-effectiveness of RZV and LZV was compared to no vaccination strategy using a lifetime Markov model from a societal perspective. Model parameters were obtained from up-to-date published literature and statistical data. The costs associated with vaccination and medical treatment, quality-adjusted life years (QALYs), the number of herpes zoster and related complication cases averted, and the incremental cost-effectiveness ratio (ICER) were calculated. Sensitivity analyses were performed to assess the robustness of the results.

Results

Compared to the no-vaccination strategy, the RZV strategy was estimated to prevent 4,126 HZ cases and 772 postherpetic neuralgia (PHN) cases, while the LZV strategy was estimated to avert 2,355 HZ cases and 467 PHN cases. The ICER was estimated at 711.46 US $/QALY and 914.62 US $/QALY for the RZV and LZV strategies, respectively.

Conclusion

HZ vaccination could provide significant health benefits at a reasonable cost. RZV was predicted to be more cost-effective than LZV.

Cost-Effectiveness of the Pneumococcal Vaccine in the Adult Population: A Systematic Review

Objectives: Pneumococcal disease (PD), caused by S. pneumoniae, is a serious global health issue, primarily for adults over 65, due to its high mortality and morbidity rates. Recently, broader-serotype vaccines have been introduced to cope with tremendous hospital costs and decreasing quality of life. Our study aims to systematically review the cost-effectiveness of current PCVs (pneumococcal conjugate vaccines) and PPVs (pneumococcal polysaccharide vaccine) from 2018 to April 2024. Methods: Articles were identified through PubMed, Embase, and Cochrane. Key outcomes include an improved incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALY), with the article's quality assessed via the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). In total, 23 studies were included, with 22 studies of high quality and 1 of moderate quality. Results: These articles showed that PCV20 was the most cost-effective option compared with other vaccines, including PPV23, PCV13, PCV15, and PCV15/PPV23, for both young and older adults, regardless of risk factors. PCV20, when used alone, saved greater costs than PCV20, followed by PPV23. Conclusions: For countries applying lower-valency vaccines, switching to PCV20 as a single regimen would be the most beneficial for averting pneumococcal cases and reducing costs in adults aged 18-64 and over 65.

Vaccine uptake, associated factors and reasons for vaccination status among the South African elderly; findings and next steps

OBJECTIVES

The elderly are particularly prone to complications from a number of vaccine-preventable diseases. However, there are limited data on vaccine uptake for this vulnerable population in South Africa. Consequently, this study investigated influenza, pneumococcal and shingles vaccine uptake among elderly people in South Africa; reasons for their vaccination status; and factors associated with their uptake.

METHODS

Cross-sectional study using an interviewer-administered questionnaire to survey 985 consenting adults aged ≥65 years in 2018. Participants were recruited from across South Africa. Bivariate analysis was used to identify socio-demographic variables associated with vaccine uptake, with multivariate logistic regression analysis used to identify key factors associated with vaccine uptake.

RESULTS

Influenza vaccine uptake was 32.3% (318/985), with uptake highest in those aged 85-90 years. Pneumococcal and shingles vaccine uptake was 3.8% (37/985) and 0.4% (4/985) respectively, being highest among those aged >90 years. The strongest statistically significant predictors for influenza vaccination were previous influenza vaccination (OR: 8.42 [5.61-12.64]); identifying as 'Coloured' (OR: 8.39 [3.98-17.69]); and residing in Gauteng Province (OR: 5.44 [3.30-9.02]). The strongest statistically significant predictors of receiving pneumococcal vaccination included receiving influenza vaccination (OR = 10.67 [3.27-37.83]); residing in the Western Cape Province (OR: 7.34 [1.49-36.22]); identifying as 'Indian' (OR: 5.85 [2.53-13.55]); and having a university education (OR: 5.56 [1.25-24.77]). Statistically significant barriers to receiving influenza vaccination included following the Traditional African religion (OR: 0.08 [0.01-0.62]) and residing in Limpopo Province (OR: 0.16 [0.04-0.71]). The main reasons for non-vaccination were considering influenza as a mild illness (36.6%; 242/661), and lack of knowledge about the pneumococcal (93.4%; 886/948) and shingles (95.2%; 934/981) vaccines.

CONCLUSION

Vaccine uptake for all vaccines was sub-optimal, with multiple non-modifiable factors predicting vaccine uptake. These pre-COVID-19 data provide a baseline for measuring the effectiveness of future interventions to increase vaccine uptake and safeguard the health of the elderly.

Persistence of antibody to 23-valent pneumococcal polysaccharide vaccine: a 5-year prospective follow-up cohort study

BACKGROUND

Pneumococcal vaccines are effective in preventing pneumococcal diseases in adults. The evaluation of the antibodies persistence to the 23-valent pneumococcal polysaccharide vaccine (PPV23) could provide evidence on PPV23 revaccination.

RESEARCH DESIGN AND METHODS

Adults aged ≥ 60 years were selected and vaccinated with PPV23 in Shanghai, and followed up for 5 years with blood samples collection of a 1-year interval. The geometric mean concentrations (GMC) of the IgG against 23 pneumococcal serotypes covered by PPV23 were detected using enzyme-linked immunosorbent assay. The antibodies to 23 pneumococcal serotypes among different groups was analyzed using statistical analysis.

RESULTS

Overall, 517 participants completed all six visits over a 5-year period (2013-2018). The GMC of 23 serotypes in adults aged ≥ 60 years decreased slowly after PPV23 vaccination compared to baseline pre-vaccination (P < 0.05), except serotype 3. Additionally, the multiplicative increase in the antibody concentration after PPV23 vaccination was greater, and the antibody levels of serotypes 1 and 6B were significantly higher at visit 5 than at visit 4 (P < 0.05).

CONCLUSIONS

The pneumococcal antibodies in elderly after PPV23 vaccination could sustain high levels over long-term follow-up, which suggested that the interval of revaccination with PPV23 in elderly should be at least 5 years after the first vaccination.

Cost-Effectiveness of Recombinant Zoster Vaccine for Adults Aged ≥50 Years in China

INTRODUCTION

Adjuvanted recombinant zoster vaccine (RZV) was the first vaccine made available for herpes zoster in China. Authors aimed to evaluate its economic and health impacts on Chinese adults aged ≥50 years.

METHODS

A lifetime Markov model was developed to compare the cost-effectiveness of RZV with that of no vaccination from a societal perspective. Model inputs were derived from published literature and analyzed in 2022. Outcomes included total costs, quality-adjusted life-years, incremental cost-effectiveness ratio, and number of herpes zoster and herpes zoster-related cases. Sensitivity analyses were performed to examine the robustness of the model results.

RESULTS

RZV was more costly than no vaccination by $2.78 billion with an additional 65,008 quality-adjusted life-years gained and could avoid 1,893,530 herpes zoster cases, 295,761 postherpetic neuralgia cases, 51,734 other complications, and 229 herpes zoster-related deaths. Incremental cost-effectiveness ratios of RZV varied in a range of $34,465.5-$51,002.7 per quality-adjusted life-year. RZV for the entire cohort would be cost-effective when discount rate was <2.4%, a waning rate of 2-dose RZV efficacy decreased to <0.8%, the utility of postherpetic neuralgia was <0.496, duration of postherpetic neuralgia was >12.86 months, or the cost of RZV per dose decreased to <$229.6. In a probabilistic sensitivity analysis, the probability of RZV being cost-effective was 43.95%, 59.32%, 45.27%, and 39.50% for people aged 50-59, 60-69, 70-79, and ≥80 years, respectively, with threefold gross domestic product per capita (37,654.5 per quality-adjusted life-year) as the willingness-to-pay threshold.

CONCLUSIONS

RZV was most likely to be cost-effective in people aged 60-69 years. A slight decrease in vaccine cost would result in RZV being cost-effective in all people aged ≥50 years.

A narrative review on vaccination rate and factors associated with the willingness to receive pneumococcal vaccine in Chinese adult population

The 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is the only approved vaccine for pneumococcal diseases in elderly Chinese population. Though regional studies explored the PPSV-23 vaccination coverage rates and influencing factors in China, a large-scale, nation-wide epidemiological surveillance studies to understand the different factors impeding pneumococcal vaccination rate are required. Hence, this review summarized PPSV-23 coverage rate, analyzed and identified vaccination influencing factors among elderly population across China by exploring articles published in CNKI, Wanfang and PubMed databases. Pneumococcal vaccination coverage rate was found to be low at around 1.23%~42.10% in China. Co-morbidities, knowledge, attitude, perception toward pneumonia and PPSV-23, education level, socio-economic disparities, health education and local policies were some of the factors associated with vaccination willingness among elderly Chinese population. Interventions or policies like government funding, subsidies, inclusion of PPSV-23 in medical insurance, or systematic encouragement from HCPs as key strategies should be implemented to encourage vaccination.