ArticleInfectious diseases and therapy2026
Economic Evaluation of PCV21 Use in Populations with Increasing Serotype 4 Invasive Pneumococcal Disease in the US: An Attributable Fraction Threshold Analysis.
Article in Infectious diseases and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe 21-valent pneumococcal conjugate vaccine (PCV21) covers 83-88% of IPD in US adults but does not include serotype 4 (ST4), which is covered by previously recommended vaccines (PPSV23, PCV15, PCV20). Recent increases in IPD cases due to ST4 have been observed, particularly among adults under 65, including Native American/Alaskan Native and those with social risk factors. As a result, the Advisory Committee on Immunization Practices (ACIP) recommends ST4-containing vaccines (PPSV23, PCV15, and PCV20) for populations with ≥ 30% ST4 IPD cases. In this study, we aimed to analyze ST4 attributable fraction (AF) thresholds for health and economic outcomes of PCV21 versus PCV20 vaccination in US adults aged 19-49 and 50-64 years with underlying medical conditions.
methodsWe used a validated Markov model to estimate incremental cost-effectiveness ratios (ICERs) for PCV21 versus PCV20 and identified ST4 AF thresholds in which the ICER shifted from 'cost-saving' to 'not cost-effective'. The analysis involved a hypothetical 1 million at-risk adults aged 19-49 and 50-64 years.
resultsPCV21 remained cost-saving compared to PCV20 when ST4 accounted for ≤ 27% (age 19-49) or ≤ 36% (age 50-64) of IPD. When ST4 increases were applied to both IPD and NBPP, these thresholds decreased to ≤ 21% and ≤ 28%, respectively.
conclusionFor populations experiencing moderate increases in the proportion of ST4 (i.e., < 30%), PCV21 may offer health and economic benefits over PCV20 for US adults aged 19-64 years with underlying medical conditions. However, in populations with ≥ 30% ST4, ST4-containing vaccines should be used as per ACIP guidance.
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