Consideration of intersectoral costs and benefits in health economic evaluations of pneumococcal conjugate vaccines: a systematic review.

Clinical Snapshot

Key Findings

• P Value: Not applicable — systematic review with narrative synthesis; no formal statistical pooling performed

• Effect Size: Median QALY-based ICER reduction: −3.25% (patient/family costs and productivity loss) to −46.02% (children, ecological effects included); Median DALY-based ICER reduction: −22.97% (ecological effects); 10 studies showed PCV dominance over no vaccination with ICBs; 16 head-to-head studies showed PCV dominance with ICBs

• Primary Outcome: Impact of including intersectoral costs and benefits (ICBs) on incremental cost-effectiveness ratios (ICERs) of pneumococcal conjugate vaccines compared to no vaccination or alternative vaccines

• Nnt Or Sensitivity: Not directly applicable; cost-effectiveness expressed as ICER per QALY or DALY averted. Inclusion of ecological effects (herd immunity, cross-protection) produced the largest ICER reductions (up to −46.02%), while serotype replacement was the only ICB associated with unfavourable cost-effectiveness impacts

• Confidence Interval: Not reported at the review level; individual study uncertainty not synthesised

Clinical Application

The review's primary output is a methodological framework for ICB inclusion in economic evaluations rather than a direct clinical intervention. Implementation requires health technology assessment bodies (e.g., PBAC in Australia) to mandate societal perspective analyses and standardise ICB categories. Dynamic transmission modelling capacity is required to capture ecological effects, which may be resource-intensive for lower-income settings. Australia's National Immunisation Program (NIP) currently funds PCV13 (Prevenar 13) for infants and PCV23 (Pneumovax 23) for at-risk adults and those aged ≥70 years, with PCV15 and PCV20 under TGA evaluation. The Pharmaceutical Benefits Advisory Committee (PBAC) typically evaluates vaccines from a healthcare system perspective; this review provides evidence that societal perspective analyses — including productivity losses, herd immunity, and equity effects — substantially improve PCV cost-effectiveness estimates. RACGP guidelines emphasise pneumococcal vaccination for at-risk adults; the finding that ecological effects reduce ICERs by up to 46% in children is directly relevant to PBAC submissions for next-generation PCV formulations (PCV15, PCV20). The equity dimension is particularly relevant to Aboriginal and Torres Strait Islander communities, who bear a disproportionate burden of invasive pneumococcal disease and for whom NIP coverage is a priority. All age groups considered for PCV vaccination, including infants and young children in national immunisation programs, older adults (≥65 years), and immunocompromised individuals. The framework is applicable across both high-income and low-to-middle-income country settings, with adaptation required for local epidemiology and cost structures.

Abstract

OBJECTIVES: This systematic review explores which intersectoral costs and benefits (ICBs) are considered in the economic evaluation of pneumococcal conjugate vaccines (PCVs) across different age groups and the related impacts on the results of economic evaluations. METHODS: Seven databases were searched from 2009 to 2024 for full economic evaluations (Ees) of PCVs from a societal perspective. ICBs were presented narratively and in tabular form. Studies were appraised on quality, and PRISMA guidelines were followed. RESULTS: In all, 57 studies were included. ICBs were captured in the following sectors: patient and family, paid labor (productivity), nonpaid productivity, other sectors (education, leisure, consumption), unspecified sectors for ecological effects (herd immunity, serotype replacement, cross-protection), and equity. In cases where the comparator was no vaccination, 10 studies reported that PCVs were dominant when ICBs were included. After excluding dominant analyses, the median QALY-based incremental cost-effectiveness ratio (ICER) reduction ranged from -3.25 percent (for patient/family costs and productivity loss) to -46.02 percent (in children with ecological effects). Among DALY-based studies, the inclusion of ecological effects reduced the median ICER by -22.97 percent. In head-to-head comparisons, 16 studies reported that PCVs were dominant when ICBs were included. CONCLUSION: Inclusion of ICBs, except for serotype replacement, showed favorable cost-effectiveness results. This study provides a framework for identifying the intersectoral costs and benefits for the health economic evaluation of PCVs in children and adults.

References

1. 1.Almomani, E., Dukuray, M., van der Putten, I., Paulus, A., Al-Lahham, A., & van Mastrigt, G. A. P. G. (2026). Consideration of intersectoral costs and benefits in health economic evaluations of pneumococcal conjugate vaccines: a systematic review. International Journal of Technology Assessment in Health Care. https://doi.org/10.1017/S0266462326103912