1

Economic Assessment of Routine PCV20 for Children

Charles Stoecker

Tulane University

School of Public Health and Tropical Medicine

ACIP

June 22, 2023
2

Conflicts of Interest

 Dr. Stoecker has no conflicts of interest to declare.
3

Acronyms

 PCV: pneumococcal conjugate vaccine  PCV13: 13 valent PCV  PCV15: 15 valent PCV  PCV20: 20 valent PCV  PPSV23: 23 valent pneumococcal polysaccharide vaccine  VE: vaccine effectiveness  VT: vaccine type  ST: serotype  AOM: acute otitis media  NBP: non-bacteremic pneumonia  IPD: invasive pneumococcal disease  IPT: inpatient  OPT: outpatient  QALY: quality adjusted life year  IC: immunocompromised  CMC: chronic medical conditions, but not IC  CPI: Consumer price index  NIS: National Immunization Survey  ABCs: Active Bacterial Core Surveillance System
4

Policy Question 1

 Should PCV20 be recommended as an option for 

pneumococcal conjugate vaccination according to currently 

recommended dosing and schedules, for U.S. children aged 

<2 years?

 Evaluate the disease and cost impacts of using PCV20 in 

place of existing conjugate vaccines in six interventions:

Intervention Comparator Population

PCV20 PCV13 Healthy

PCV20+PPSV PCV13+PPSV CMC

PCV20+PPSV+PPSV PCV13+PPSV+PPSV IC

PCV20 PCV15 Healthy

PCV20+PPSV PCV15+PPSV CMC

PCV20+PPSV+PPSV PCV15+PPSV+PPSV IC

Conjugate doses are given in a 3+1 schedule (3 doses at age 0, 1 dose at age 1),

PPSV doses are given at age 2 for CMC & IC and at age 7 for IC
5

Policy Question 2

 Should PCV20 without PPSV23 be recommended as an 

option for pneumococcal vaccination for U.S. children aged 

2–18 years with underlying medical conditions that 

increase the risk of pneumococcal disease?

 Evaluate the disease and cost impacts of using PCV20 in 

place of existing schedules that include conjugate and 

polysaccharide in six interventions:

Intervention Comparator Population

PCV20 PCV13+PPSV CMC

PCV20 PCV13+PPSV+PPSV IC

PCV20 PCV15+PPSV CMC

PCV20 PCV15+PPSV+PPSV IC

PCV20+PPSV PCV20 CMC

PCV20+PPSV+PPSV PCV20 IC

Conjugate doses are given in a 3+1 schedule (3 doses at age 0, 1 dose at age 1),

PPSV doses are given at age 2 for CMC & IC and at age 7 for IC
6

Methods

 Cohort model

 United States birth cohort 3,939,295

• 91.1% healthy a

• 8.8% CMC a

• 0.1% IC a

• Background mortality rates from National Center for Health Statistics 

Vital Statistics

 Societal perspective

• Medical & nonmedical (work loss) costs

 All future outcomes (health & cost) discounted at 3%

 Costs inflated to 2022$ by CPI or CPI Medical Care

 Disease incidence followed for 15 years after final PCV20 shot

• Direct & indirect protection followed over this cohort

• QALY losses from death and permanent disease states aggregated 

over the lifetime a Pelton 2014. Tables 1 & 2.
7

Outcomes

 IPD cases (meningitis & other)

 Meningitis sequelae (deafness & other disability)

 Non-invasive pneumonia (inpatient & outpatient)

 Otitis media & tympanostomy tube placement

 Deaths

 QALYs & life years

 Costs

 Cost/QALY
8

Complete Series PCV Vaccine Effectiveness

VE Reference

VT IPD (except ST3, ST19F) 86 (76, 92) Moore 2016

ST3 IPD 26 (0, 68) Andrews 2014

ST19F IPD 75 (37, 90) Andrews 2014

VT NBP (except ST3, ST19F) 51.6 (45.6, 55.2) b

ST3 NBP 15.6 (0, 40.8) b

ST19F NBP 45 (22.2, 54) b

VT AOM (except ST3, ST19F) 54 (41, 64) Eskola 2001

ST3 AOM 16.3 (12.4, 19.3) c

ST19F AOM 47.1 (35.8, 55.8) d

Note: The displayed VE values apply only after receipt of 4th dose. VE during the 1st year (age 0-1) is 75.7% of these numbers. 

(Adapted from Whitney et al. 2006)

b Applied ratio of VE for NBP to VE for IPD for adults from CAPITA study to pediatric VEs vs IPD above

c Applied ratio of pediatric ST3 IPD to other VT IPD above to Eskola estimate for VT AOM 

d Applied ratio of pediatric ST19F IPD to other VT IPD above to Eskola estimate for VT AOM
9

PPSV Vaccine Effectiveness

VE Source

VT IPD 59.7 (47.4, 69.1) Falkenhorst 2017 & 

Thorrington 2018

VT NBP 20 (0, 40) ACIP WG Discussion

VT AOM 0 ACIP WG Discussion
10

Indirect Effects

 Effects on other children

 Apply to unvaccinated children and children whose vaccination protection is not 

100% (i.e., all children)

 Apply to PCV20 unique types only

 Remove 7.8% of disease each year

 Effects on adults

 For childhood cohort model, modeled effects on all U.S. adults (258 million)

 Used inputs from our model previously used to analyze PCV20 effects on adults

 Modeled 1 year of impacts on adults for this childhood cohort

• 2nd year of impacts on adults would be influenced by 2nd childhood cohort, etc.

 Used output from previously used CDC WinBUGS model that shows each childhood 

cohort responsible for 4.12% decline in previous year’s disease on average

• We modified this 4.17% to account for an anticipated 15 years of use to arrive at an average of 3.12% 

disease reduction per childhood cohort

 Indirect effects from adults (QALYs and cost savings) were then apportioned to 

each risk status of children according to their contribution to total QALYs saved. 

• If vaccinating healthy children was responsible for 50% of total QALYs saved among 

children, then 50% of cost and QALY savings from adults were allocated to the healthy 

group.
11

Other Vaccine Assumptions

 Coverage

 3-dose PCV series (completed by 13 months, applied to 1st year)

• 94.2% (93.6, 94.8) Hill MMWR 2023

 4-dose PCV series

• 81.9% (80.9, 82.2) Hill MMWR 2023

 1st dose PPSV (CMC & IC)

• 78.1%

 2nd dose PPSV (IC)

• 64.0%

 Waning

 PCV: Years 0-5 get full VE

• Waning linearly to 0% over next 10 years

 PPSV: Wane linearly to 50% in first 5 years

• Wane linearly to 30% in next 5

• Wane to 0% in last 5 years

 Adverse events

 All vaccines were assumed to have no adverse events
12

AOM Incidence

Age 0 1 2 3 4

All cause AOM visits, 

 healthy (per 1k) a

507 

(358,701)

507 

(358,701)

319 

(229,435)

319 

(229,435)

319 

(229,435)

All cause AOM visits, 

 CMC/IC (per 1k) b

1533 

(1083,2117)

1533 

(1083,2117)

686 

(491,936)

686 

(491,936)

686 

(491,936)

% of AOM with tympanostomy 

tube insertion c 12% (6-15) 12% (6-15) 8% (4-15) 8% (4-15) 8% (4-15)

% pneumococcal AOM d 14.0% 14.0% 16.0% 16.0% 16.0%

Note: No AOM incidence assumed for ages 5+.

a overall numbers from National Ambulatory Medical Survey/National Hospital Ambulatory Medical Care Survey+Market Scan data 

2016+2018,

b Market Scan Data 2016-2018

c Pichichero et al. 2013

d Kaur et al. 2022
13

NBP Incidence

Age 0 1 2 3 4 5 6 7 8 9+

OPT NBP, healthy (per 

100k) a

640 

(594,686)

1291 

(1192,1386)

1512 

(1368,1658)

785 

(715,859)

639 

(583,693)

678 

(618,733)

575 

(524,622)

711 

(626,800)

357 

(323,391)

319 

(294,345)

OPT NBP, CMC/IC (per 

100k) b

9249 

(56388,

65090)

18656 

(113162,

131601)

14881 

(74090,

89811)

7728 

(38714,

46492)

6294 

(31556,

37506)

5060 

(21862,

25905)

4296 

(18546,

21986)

5308 

(22121,

28290)

2664 

(11413,

13815)

2384 

(10384,

12189)

% pneumococcal c 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10) 6% (1-10)

IPT NBP, healthy (per 

100k) d 588 

(546,630)

417 

(385,448)

390 

(353,427)

202 

(184,221)

165 

(150,179)

121 

(111,131) 103 (94,112)

127 

(112,143) 64 (58,70) 57 (52,61)

IPT NBP, CMC (per 

100k) e

1642 

(1524,1759)

1164 

(1075,1250)

1087 

(984,1193)

564 

(514,617)

461 

(420,499)

544 

(496,588)

462 

(422,500)

568 

(500,639)

286 

(258,313)

255 

(235,275)

IPT NBP, IC (per 100k) 

e

3283 

(3048,3518)

2328 

(2150,2501)

2174 

(1968,2386)

1128 

(1027,1234)

922 

(840,998)

1328 

(1212,1436)

1129 

(1029,1220)

1386 

(1220,1560)

697 

(631,764)

623 

(573,672)

% IPT NPB fatality d

1.3% (1.02-

1.59)

0.53% 

(0.37-0.70)

0.40% 

(0.23-0.58)

0.42% 

(0.21-0.64)

0.61% 

(0.32-0.91)

0.39% 

(0.15-0.63)

0.32% 

(0.06-0.59)

0.78% 

(0.35-1.20)

0.51% 

(0.13-0.89)

1.72% 

(1.42-2.01)

% pneumococcal c 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20) 12% (2-20)

a overall mean from Tong et al. 2018, 5th & 95th percentiles calculated using the ratio of 5th & 95th to mean in IPT NBP for each age; adjusted by (1-% CMC+IC pop * CMC+IC 

ratio)/% healthy pop; CMC+IC ratio from MarketScan 2016-2018

b based on Tong et al. 2018, but scaled by age-specific ratios of CMC+IC to healthy calculated from MarketScan 2016-2018

c Adapted from Jain et al. 2015 with expert input.

d Overall numbers from 2018-2019 NIS Data, scaled by (1-(% IC pop * IC ratio + % CMC pop * CMC ratio)) / % healthy pop, ratios for IC and CMC from Pelton et al. 2014

e Overall numbers from 2018-2019 NIS Data, scaled by rate ratios for health: CMC:IC from Pelton et al. 2014
14

IPD Incidence

Age 0 1 2 3 4 5 6 7 8 9+

IPD Incidence, 

healthy (per 

100k) a

14 (11, 16) 10 (7, 12) 5 (3, 6) 5 (3, 6) 3 (2, 4) 5 (3, 6) 3 (1, 4) 2 (1, 3) 1 (0, 2) 1 (1, 1)

IPD Incidence, 

CMC (per 

100k) a

24 (20,29) 18 (13,22) 8 (5,11) 9 (5,11) 6 (4,7) 15 (10,20) 9 (3,13) 7 (3,10) 5 (0,7) 3 (3,3)

IPD Incidence, 

IC (per 100k) a

152

(123,179)

112

(78,134)

51

(34,67)

54

(34,67)

34

(22,45)

182 

(120,241)

112 

(40,160)

81

(40,120)

56

(0,80)

40

(40,40)

% meningitis a 15.87 

(14.45,17.43)

15.87 

(14.45,17.43)

15.87 

(14.45,17.43)

15.87 

(14.45,17.43)

15.87 

(14.45,17.43)

20.05 

(18,22.33)

20.05 

(18,22.33)

20.05 

(18,22.33)

20.05 

(18,22.33)

20.05 

(18,22.33)

% meningitis 

resulting in 

fatality a

10.48 

(7.85,13.99)

10.48 

(7.85,13.99)

10.48 

(7.85,13.99)

10.48 

(7.85,13.99)

10.48 

(7.85,13.99) 0.00% 0.00% 0.00% 0.00% 0.00%

% other IPD 

resulting in 

fatality a

3.61

(2.92,4.47)

3.61

(2.92,4.47)

3.61 

(2.92,4.47)

3.61 

(2.92,4.47)

3.61 

(2.92,4.47)

3.83 

(2.93,5.02)

3.83 

(2.93,5.02)

3.83 

(2.93,5.02)

3.83 

(2.93,5.02)

3.83 

(2.93,5.02)

a ABC’s data 2018-2019.

b Olarte et al. 2015; Edmond et al. 2010

Age 0-4 5+

Disability % b 7 (4, 11) 11 (8, 18)

Deafness % b 9 (7, 13) 14 (11, 22)

Meningitis Sequelae
15

IPD/NBP Serotype Distributions

Age 0 1 2 to 5 6+

% PCV13 (+6C-3-19F) 3.68% 1.23% 9.76% 10.64%

% ST3 11.90% 3.68% 10.93% 14.22%

% ST19F 7.35% 7.37% 5.65% 9.17%

% PCV15 only (ST 22F, 33F) 17.41% 21.01% 14.97% 14.14%

% PCV20 only 12.86% 19.78% 11.45% 13.52%

% PPSV23 only 1.84% 1.23% 0.73% 5.83%

% PCV13 (+6C-3-19F) 3.06%

% ST3 3.06%

% ST19F 3.06%

% PCV15 only (ST 22F, 33F) 8.16%

% PCV20 only (ST 8, 10A, 11A, 

12F, 15B) 23.47%

AOM Serotype Distributions

IPD serotype distributions from ABCs data 2018-2019. Applied to NBP by assumption.

AOM serotype distributions from Kaur et al. 2022 modified by expert input.
16

Vaccine Prices

PCV13 Private $226.43 CDC Price Listb

PCV13 Public $158.18 CDC Price List

PCV15 Private $216.086 CDC Price Listb

PCV15 Public $162.27 CDC Price List

PCV20 Private $253.96 a 

PCV20 Public $187.27 a 

PPSV23 Private $117.08 CDC Price Listb

PPSV23 Public $65.80 CDC Price List

Vaccine Admin $30.13 Tsai Prev Med Reports 2019

Travel/Caregiver Time $35.96 Maciosek Am J Prev Med 2006

a Ratio of PCV20:PCV15 cost in adults separately for public and private from CDC Price list and applied to PCV15 costs in children. 

Estimation procedure discussed with manufacturer.

b Private list price inflated 7.1% to account for differences between CDC private list price and average reimbursement (Leidner et al. 

2021)
17

Disease Cost ($)

Medical cost a

Non-medical 

cost b, c

Disability $258,084 ($206,467, $309,701) $1,413,847 

Deafness $48,354 ($38,683, $58,025) $583,399 

AOM $83 ($67, $100) $253 

Tymp tube $3,610 ($2,888, $4,332) $253 

IPD $19,196 ($15,357, $23,035) $624 

IPD-mening $25,691 ($20,553, $30,829) $3,273 

IPT NBP $10,965 ($8,772, $13,158) $624 

OPT NBP $351 ($281, $421) $467 

a Medical costs are from MarketScan 2004-2006 data inflated to 2022$ using Medical component of CPI. Ranges +/- 20%. 

b Disability & deafness: MMWR 53(03);57-59 and Errata. E.g.: assistive devices, home modifications, special education costs, 

productivity losses, etc.

c Other conditions: Ray et al. 2006 PIDJ
18

QALY Decrements

AOM 0.0016 (0, 0.0155)

Tymp tube 0.0016 (0, 0.0155)

OPT NBP 0.0004 (0.0001, 0.0329)

IPT disease (not mening) 0.0105 (0.0001, 0.0155)

IPD mening no sequelae 0.0165 (0.0001, 0.0166)

Deafness 0.2137 (0.07, 0.72)

Disability 0.2456 (0.16, 0.49)

QALY decrement are low, median, and high estimates from the survey by Tang et al. 2021. The upper bound of AOM is capped at the 

upper bound of inpatient disease. Tympanostomy tube placement which follows Delgleize et al. 2016 in setting equal to AOM.

QALY decrements are scaled by background QALY values which range from 0.94 for age 0 to 0.92 for age 15 (Erickson et al. Statistical 

Notes 1995)
19

Indirect Effects from Adult Program

Base

(indirect rate = 

3.17%)

10% less effective 

(indirect rate = 

2.853%)

Same effect as on 

kids

(indirect rate = 7.8%)

Health Outcomes

IPD cases -182 -164 -447

IPT pneumonia cases -3,210 -2,889 -7,899

OPT pneumonia Cases -7,335 -6,601 -18,048

Deaths due to IPD -24 -21 -59

Deaths due to pneumonia -127 -115 -314

QALYs 1,262 1,136 3,105

Life-years 1,849 1,664 4,549

Costs (million $)

Total cost -$80 -$72 -$197

Medical costs -$80 -$72 -$197

Vaccine costs $0 $0 $0
20

Policy Questions

1. PCV20 in place of existing conjugate vaccines among 

all risk groups.

2. PCV20 in place of existing schedules that include 

conjugate and polysaccharide among CMC & IC 

populations
21

Direct Swap PCV20 for PCV13

PCV20 vs PCV13

PCV20+PPSV vs 

PCV13+PPSV

PCV20+PPSV+PPSV vs 

PCV13+PPSV+PPSV 

Healthy CMC IC

IPD meningitis cases -55 -8 -1

IPD non-meningitis cases -276 -40 -3

Deafness -4 -1 0

Disability -6 -1 0

IPT pneumonia cases -1,106 -277 -7

OPT pneumonia cases -1,798 -1,552 -18

AOM cases -145,371 -36,645 -444

Tymp tubes -14,647 -3,815 -46

Deaths due to IPD -14 -2 0

Deaths due to pneumonia -8 -2 0

Childhood QALYs 917 190 7

Adult QALYs (indirect) 1,039 215 8

Life-years 685 128 7

Costs (million $)

Total cost $153 -$17 -$0.92

Medical costs -$108 -$27 -$0.56

Non-medical costs -$52 -$13 -$0.27

Adult costs (indirect) -$66 -$14 -$0.53

Vaccine costs $379 $37 $0.44

Cost ratios ($)

Cost/QALY 78,115 Cost-saving Cost-saving

Cost/life-year 223,192 Cost-saving Cost-saving

Policy Question 1
22

Direct Swap PCV20 for PCV15

PCV20 vs PCV15

PCV20+PPSV vs 

PCV15+PPSV

PCV20+PPSV+PPSV vs 

PCV15+PPSV+PPSV

Healthy CMC IC

IPD menigitis cases -25 -4 0

IPD non-meningitis cases -125 -18 -2

Deafness -2 0 0

Disability -3 0 0

IPT pneumonia cases -500 -126 -3

OPT pneumonia cases -824 -716 -8

AOM cases -107,856 -27,188 -329

Tymp tubes -10,867 -2,830 -34

Deaths due to IPD -7 -1 0

Deaths due to pneumonia -4 -1 0

Childhood QALYs 488 104 4

Adult QALYs (indirect) 1,033 221 8

Life-years 308 58 3

Costs (million $)

Total cost $234 -$1 -$0.48

Medical costs -$68 -$17 -$0.32

Non-medical costs -$35 -$9 -$0.16

Adult costs (indirect) -$65 -$14 -$0.48

Vaccine costs $402 $39 $0.47

Cost ratios ($)

Cost/QALY 153,715 Cost-saving Cost-saving

Cost/life-year 757,901 Cost-saving Cost-saving

Policy Question 1
23

Direct Swap PCV20 for PCV15

Sensitivity Analysis: PCV20 VE 10% Lower

PCV20 vs PCV15 

PCV20+PPSV vs 

PCV15+PPSV 

PCV20+PPSV+PPSV vs 

PCV15+PPSV+PPSV

Healthy CMC IC

IPD meningitis cases -16 -2 0

IPD non-meningitis cases -82 -10 -1

Deafness -1 0 0

Disability -2 0 0

IPT pneumonia cases -392 -95 -2

OPT pneumonia cases -651 -542 -6

AOM cases -85,628 -21,597 -262

Tymp tubes -8,633 -2,250 -27

Deaths due to IPD -4 -1 0

Deaths due to pneumonia -3 -1 0

Childhood QALYs 360 76 2

Adult QALYs (indirect) 933 197 6

Life-years 216 39 2

Costs (million $)

Total cost $263 $6 -$0.22

Medical costs -$53 -$13 -$0.22

Non-medical costs -$27 -$7 -$0.11

Adult costs (indirect) -$59 -$12 -$0.36

Vaccine costs $402 $39 $0.47

Cost ratios ($)

Cost/QALY 203,365 23,832 Cost-saving

Cost/life-year 1,216,977 168,181 Cost-saving

Policy Question 1
24

Direct Swap PCV20 for PCV15

Sensitivity Analysis: Adult Indirect Effects 7.8%

PCV20 vs PCV15 

PCV20+PPSV vs 

PCV15+PPSV 

PCV20+PPSV+PPSV vs 

PCV15+PPSV+PPSV 

Healthy CMC IC

IPD meningitis cases -25 -4 0

IPD non-meningitis cases -125 -18 -2

Deafness -2 0 0

Disability -3 0 0

IPT pneumonia cases -500 -126 -3

OPT pneumonia cases -824 -716 -8

AOM cases -107,856 -27,188 -329

Tymp tubes -10,867 -2,830 -34

Deaths due to IPD -7 -1 0

Deaths due to pneumonia -4 -1 0

Childhood QALYs 488 104 4

Adult QALYs (indirect) 2,542 545 19

Life-years 308 58 3

Costs (million $)

Total cost $138 -$21 -$1.18

Medical costs -$68 -$17 -$0.32

Non-medical costs -$35 -$9 -$0.16

Adult costs (indirect) -$161 -$35 -$1.17

Vaccine costs $402 $39 $0.47

Cost ratios ($)

Cost/QALY 45,551 Cost-saving Cost-saving

Cost/life-year 447,389 Cost-saving Cost-saving

Policy Question 1
25

Direct Swap PCV20 for PCV15, Healthy

Multivariate Sensitivity, 90% Confidence Interval

PCV20 vs PCV15 5th 95th

Healthy Healthy Healthy

IPD meningitis cases -25 -28 -21

IPD non-meningitis cases -125 -135 -104

Deafness -2 -3 -1

Disability -3 -4 -2

IPT pneumonia cases -500 -829 -82

OPT pneumonia cases -824 -1,363 -136

AOM cases -107,856 -130,202 -87,612

Tymp tubes -10,867 -14,286 -7,866

Deaths due to IPD -7 -8 -5

Deaths due to pneumonia -4 -6 -1

Childhood QALYs 488 362 1,263

Adult QALYs (indirect) 1,033 402 2,541

Life-years 308 206 388

Costs (million $)

Total cost $234 $135 $279

Medical costs -$68 -$85 -$49

Non-medical costs -$35 -$42 -$30

Adult costs (indirect) -$65 -$162 -$24

Vaccine costs $402 $401 $404

Cost ratios ($)

Cost/QALY 153,715 51,105 210,518

Cost/life-year 757,901 409,958 1,144,176

Policy Question 1
26

Direct Swap PCV20 for PCV15, Healthy

One-way Sensitivity

Influential Inputs on Cost/QALY

All inputs were included in multivariate sensitivity analysis. The top 5 according to size of change in cost per QALY are charted 

here. Ends of bars represent the cost/QALY when the particular input is set to the min/max (or 5th & 95th) of the input 

distribution.

 $- $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000

VE PCV vs AoM !ST3 !ST19

IPT NBP due to pneumococcus

AoM QALY Decrement

Indirect Adult Costs

Indirect Adult QALYs

Policy Question 1
27

PCV20 without PPSV23, PCV13 Context

PCV20 vs PCV13+PPSV PCV20 vs PCV13+PPSV+PPSV 

CMC IC

IPD meningitis cases -7 -1

IPD non-meningitis cases -35 -3

Deafness -1 0

Disability -1 0

IPT pneumonia cases -267 -6

OPT pneumonia cases -1,497 -17

AOM cases -36,645 -444

Tymp tubes -3,815 -46

Deaths due to IPD -2 0

Deaths due to pneumonia -2 0

Childhood QALYs 180 6

Adult QALYs (indirect) 204 7

Life-years 118 6

Costs (million $)

Total cost -$55 -$1.57

Medical costs -$27 -$0.51

Non-medical costs -$12 -$0.24

Adult costs (indirect) -$13 -$0.45

Vaccine costs -$3 -$0.38

Cost ratios ($)

Cost/QALY Cost-saving Cost-saving

Cost/life-year Cost-saving Cost-saving

Policy Question 2
28

PCV20 without PPSV23, PCV15 Context

PCV20 vs 

PCV15+PPSV

PCV20 vs 

PCV15+PPSV+PPSV 

PCV20 vs PCV15+PPSV, 

Half PPSV Coverage

PCV20 vs 

PCV15+PPSV+PPSV, 

Half PPSV Coverage

CMC IC CMC IC

IPD meningitis cases -3 0 -4 0

IPD non-meningitis cases -13 -1 -21 -2

Deafness 0 0 0 0

Disability 0 0 0 0

IPT pneumonia cases -116 -2 -138 -3

OPT pneumonia Cases -661 -7 -786 -9

AOM cases -27,188 -329 -27,188 -329

Tymp tubes -2,830 -34 -2,830 -34

Deaths due to IPD -1 0 -1 0

Deaths due to pneumonia -1 0 -1 0

Childhood QALYs 95 3 111 4

Adult QALYs (indirect) 108 3 125 5

Life-years 48 2 64 4

Costs (million $)

Total cost -$33 -$0.91 $4 -$0.66

Medical costs -$17 -$0.26 -$18 -$0.34

Non-medical costs -$8 -$0.12 -$9 -$0.18

Adult costs (indirect) -$7 -$0.18 -$8 -$0.29

Vaccine costs -$1 -$0.35 $39 $0.15

Cost ratios ($)

Cost/QALY Cost-saving Cost-saving 18,722 Cost-saving

Cost/life-year Cost-saving Cost-saving 68,612 Cost-saving

Policy Question 2
29

Adding PPSV23 to a PCV20 Primary Series

PCV20+PPSV vs PCV20

PCV20+PPSV+PPSV vs 

PCV20

CMC IC

IPD meningitis cases -1 0

IPD non-meningitis cases -5 -1

Deafness 0 0

Disability 0 0

IPT pneumonia cases -10 -1

OPT pneumonia cases -55 -1

AOM cases 0 0

Tymp tubes 0 0

Deaths due to IPD 0 0

Deaths due to pneumonia 0 0

QALYs 9 1

Life-years 10 1

Costs (million $)

Total cost 39 $0.73

Medical costs -1 -$0.06

Non-medical costs 0 -$0.04

Vaccine costs 40 $0.82

Cost ratios ($)

Savings/QALY 4,086,881 690,388

Savings/life-year 3,923,758 658,925

Policy Question 2
30

Limitations

 Uncertainty around indirect effects on adults

 Uncertainty around QALY decrements

 AOM

 PCV20 VE based on immunogenicity trials

 Same VE for all PCV valencies

 ST3 VE limited data
31

Conclusion

Policy Question 1

 Replacing PCV13 with PCV20 costs: 

 $57k/QALY (aggregate)

• $78k/QALY (healthy)

• Cost-saving (CMC)

• Cost-Saving (IC)

 Replacing PCV15 with PCV20 costs: 

 $125k/QALY (aggregate)

• $154k/QALY (healthy)

• Cost-saving (CMC)

• Cost-saving (IC)
32

 Replacing PCV13+PPSV23 (or PCV15+PPSV23) with PCV20 

by itself in CMC/IC is cost saving

 Adding PPSV23 to PCV20 for CMC/IC costs: 

 $3.9 million/QALY (aggregate)

• $4.1 million/QALY (CMC)

• $0.7 million/QALY (IC)

Conclusion

Policy Question 2
33

Thank you!

Please send comments to:

cfstoecker@tulane.edu

Contributors:

Miwako Kobayashi

Dipreye Ayabina

Namrata Prasad

Andrew Leidner

National Center for Immunization & Respiratory Diseases

HSREB – Econ Team