Cost-effectiveness analysis of 21-valent pneumococcal conjugated vaccine among adults in Canada
Bibliographic record
Abstract
Abstract Background A 21-valent pneumococcal conjugate vaccine (PCV21) was recently authorized in Canada to protect adults against invasive pneumococcal disease (IPD). Objective To assess the cost-effectiveness of PCV21 compared to current Canadian vaccination recommendations for adults of different age and risk groups. Methods We used a static cohort model to estimate lifetime incremental cost-effectiveness ratios (ICERs), in 2023 Canadian dollars per quality-adjusted life year (QALY), discounted at 1.5%, in population cohorts aged 33 (midpoint of the 18-49 year age group), 50, and 65 years from the health system and societal perspectives. The primary analysis used 2022 serotype distributions for IPD cases. Additional analyses incorporated indirect effects from pediatric vaccination and used IPD serotype distributions from 2015-2019, to explore the impact of changes over time observed in some age groups. Results For population groups currently recommended to receive PCV20 in Canada (65 years and older, 50-64 years with additional risk factors for IPD, or 18-49 years with immunocompromising conditions), PCV21 was cost-effective at a $50,000 per QALY threshold and dominated PCV20 in most scenarios when PCV21 serotypes were more prevalent. When PCV20 serotypes were equally or more prevalent than PCV21 serotypes, results were more sensitive to assumptions about indirect effects and serotype replacement. For groups not currently recommended a conjugate vaccine (50-64 years without additional IPD risk factors and 18-49 years with chronic medical conditions or unhoused populations), use of a higher-valency conjugate vaccine was a cost-effective intervention compared to no vaccination, with the optimal vaccine dependent on the proportion of IPD attributable to PCV20 and PCV21 serotypes in the population of interest. Results were sensitive to vaccine price in most scenarios. Interpretation The use of PCV21 may be cost-effective in some populations, depending on the prevalence of IPD serotypes covered by PCV20 and PCV21.
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 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".