Expanding the use of the 15-valent pneumococcal conjugate vaccine (PCV15) or 20-valent pneumococcal conjugate vaccine (PCV20) to all adults in the United States aged 50 to 64 years would lead to modest increases in healthcare budgets over three years, according to a new study. The research suggests that the substantial burden of pneumococcal disease in this age group warrants the expanded coverage, which coudl yield important health and economic advantages, especially for Black adults aged 50 to 64 years.

Broader Vaccine Recommendations Could Lower Disease Risk

Pneumococcal disease is often considered a greater threat to individuals with underlying health issues and those aged 65 and older.Prior to October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended pneumococcal conjugate vaccines (PCV) for all adults aged 65 and older, and for those aged 19 to 64 with specific risk conditions. However, in october 2024, ACIP voted to recommend a single dose of PCV for all adults aged 50 and older who have not previously been vaccinated or have an unknown vaccination history, while maintaining the risk-based recommendations.

black Americans face a disproportionate burden of pneumococcal disease due to systemic health inequities. Research indicates that rates of invasive pneumococcal disease (IPD) are twice as high in Black adults compared to White adults. A study by “Nowalk et al” revealed significant differences in pneumococcal mortality and hospital stay lengths between Black and non-Black populations. healthy adults aged 50 to 64, as well as Black individuals, also face a higher risk of pneumococcal disease from serotypes not included in the older 13-valent PCV (PCV13).

the study’s authors propose that broader use of PCV20 or PCV15 in these populations could address the remaining disease risk and offer substantial benefits. They emphasize the importance of evaluating the economic impact of such an age-based expansion in recommendations. The study assessed the financial implications of introducing PCV15 or PCV20 vaccines among U.S. adults aged 50 to 64 years, compared to focusing on a high-risk population from the perspective of U.S. payers.

“Expansion in coverage would have significant health and economic benefits, especially for all Black adults aged 50 to 64 years.”

Economic Impact of Expanded Vaccine Programs

The researchers used a deterministic model to simulate the three-year risk of health outcomes and associated economic costs for various pneumococcal vaccination strategies in U.S. adults aged 50 to 64. They compared two scenarios: one where adults received either PCV20 or PCV15, followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) as the base case, and another where only individuals with chronic conditions received PCV20 or PCV15 followed by PPSV23 as the reference case. Economic impacts were persistent by calculating the difference in expenditures between the scenarios.

The study found that extending the PCV20 program to all U.S. adults aged 50 to 64 without high-risk conditions would result in a net budget increase of $6.5 billion over three years. Extending the combined PCV15/PPSV23 program would cost $9 billion. If the PCV20 program were exclusively extended to Black individuals aged 50 to 64, it would cost an additional $850 million over three years, with an incremental program cost increase of $1.1 billion.

Health Benefits and Broader Implications

The investigators suggest that age-based PCV20 or PCV15 followed by PPSV23 at age 50, compared to risk-based strategies, would likely reduce the burden of pneumococcal disease in adults aged 50 to 64. They also noted that age-based recommendations are easier to implement than risk-based approaches and increase opportunities to address health conditions that may elevate the risk of pneumococcal disease.

The study’s findings are relevant to both high-income and low- and middle-income countries, which face unique challenges in implementing effective pneumococcal vaccination programs, such as limited healthcare infrastructure and varying epidemiological patterns. the research highlights the potential economic savings and health improvements that could result from expanding pneumococcal vaccine recommendations if implemented effectively.