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When to Give Pneumococcal Vaccine -- Younger May Be Better
Lowering the age for giving pneumococcal vaccine from 65 to 50 yields modest benefits, according to this cost-effectiveness analysis.
Pneumococcal vaccination (PV), currently recommended for people 65 years or older, has proven safe and effective in preventing invasive pneumococcal disease in this population. The incidence and case fatality rate of such disease increase with age. In 50- to 64-year-olds, incidence is more than a third -- and the case fatality rate more than half -- of rates found in 65- to 79-year-olds.
Applying CDC data on disease incidence and fatality rates to hypothetical vaccinated and unvaccinated cohorts, public health investigators in the U.S. analyzed the cost-effectiveness of administering PV to immunocompetent 50- to 64-year-olds. Cohorts were divided by race (because invasive pneumococcal disease is 2-5 times more common in blacks than in whites) and risk level, with high risk defined as underlying congestive heart failure, chronic obstructive pulmonary disease, diabetes, cirrhosis, or chronic renal failure or alcoholism. Modest cost-effectiveness -- based on health costs and quality-adjusted life-years (QALYs) -- was seen in the general immunocompetent population, with the greatest savings in high-risk blacks (who currently have the lowest vaccination rate). Vaccinating any high-risk patient aged 50-64 was cost-effective, and even among non-high-risk immunocompetent patients, the cost per QALY gained was lower than for any other currently recommended preventive measure.
Comment: The authors and an editorialist agree that lowering the age for PV would save healthcare dollars; it would also synchronize recommended initial doses of influenza vaccine and of pneumococcal vaccine. However, data are lacking on duration of protection and on the clinical effectiveness of revaccination, if necessary. In serologic studies, second PVs have yielded less vigorous immune responses than first doses.
— Stephen G. Baum, MD
Published in Journal Watch Infectious Diseases September 5, 2003
Citation(s):
Sisk JE et al. Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: Role of comorbid conditions and race. Ann Intern Med 2003 Jun 17; 138:960-8.
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Gardner P. A need to update and revise the pneumococcal vaccine recommendations for adults. Ann Intern Med 2003 Jun 17; 138:999-1000.
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- Medline abstract (Free)