Cost-Effectiveness of Alternative Strategies for Use of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Canadian Adults
Bibliographic record
Abstract
Background. The National Advisory Committee on Immunization (NACI) recommends broad use of PCV13 in infants, the 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults ≥65 years, and both vaccines sequentially for adults with immunocompromising conditions. In light of recent PCV13 efficacy results from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), and new sero-epidemiology data on pneumonia caused by PCV13 serotypes in Canadian adults, we examined the economic implications of funding an expanded PCV13 immunization program. Methods. A microsimulation model depicting expected lifetime risks, consequences, and costs of invasive pneumococcal disease (IPD) and all-cause pneumonia (ACP) in Canadian adults was developed. PPV23 effectiveness was based on published literature; PCV13 effectiveness was based on data from CAPiTA. Rates of ACP in different age groups were estimated from the Canadian Institute of Health Information hospital Discharge Abstract Database (CIHI DAD). The pro portion of ACP caused by PCV13 serotypes was estimated from the Serious Outcomes Surveillance (SOS) Network using serotype-specific urinary antigen detection assay. Herd effects were included in the model based on previous observations with PCV7 in Canada. Outcomes and costs were evaluated for three alternative populations: (1) immunocompromised persons 18-99 at model entry (n = 1.4M); (2) immunocompromised persons 18-64 and all persons ≥65 at model entry (n = 6.2M); and (3) immunocompromised and high-risk persons 18-64 and all persons ≥65 at model entry (n = 13.8M). Vaccination strategy compared use of PPV23 alone “current strategy” with use of PCV13 followed by PPV23 “proposed strategy”. Results. Implementing an expanded program with PCV13 followed by PPV23 (in lieu of PPV23 alone) would be cost saving for populations 1 and 2 and highly cost-effective for population 3 (table). Table. Cost-Effectiveness of Proposed Strategies for Expanded Use of PCV13 Conclusion. Implementing the proposed vaccine program with PCV13 followed by PPV23 in Canadian adults would be cost-saving or a highly cost-effective use of scarce healthcare resources. Disclosures. D. Weycker, Pfizer Inc: Research Contractor, Research support; M. Atwood, Pfizer Inc: Consultant, Consulting fee; R. Sato, Pfizer Inc: Employee and Shareholder, Salary; L. Beausoleil, Pfizer Canada Inc: Employee, Salary; C. Laferriere, Pfizer Canada: Employee and Shareholder, Salary; S. A. Mcneil, Pfizer Canada Inc: Grant Investigator and Scientific Advisor, Grant recipient
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".