• Kenneth J Smith, Angela R Wateska, Mary Patricia Nowalk, Chyongchiou J Lin, Lee H Harrison, William Schaffner, and Richard K Zimmerman.
• University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: smithkj2@upmc.edu.
• Am J Prev Med. 2024 Nov 29.

IntroductionThe potential impact of an in-development 24-valent pneumococcal conjugate vaccine compared with that of currently recommended vaccines in older adults is unclear. Similar to most currently available pneumococcal conjugate vaccines, 24-valent pneumococcal conjugate vaccine's formulation is based on childhood pneumococcal disease epidemiology. Decision analysis techniques were used to estimate 24-valent pneumococcal conjugate vaccine cost-effectiveness and public health effects in U.S. older adults.MethodsA Markov model compared 24-valent pneumococcal conjugate vaccine with currently recommended U.S. pneumococcal vaccination strategies in older adults (aged ≥65 years) and with no vaccination. Age-, race-, and chronic medical condition-specific pneumococcal illness risks and serotype-specific disease risks were obtained from Centers for Disease Control and Prevention data. Vaccine effectiveness was estimated using Delphi panel and clinical trial data. Vaccination and pneumococcal illness costs were from U.S.DatabasesScenario analyses examined indirect effects of childhood pneumococcal vaccination on adult disease. Data were collected and analyses were performed in 2024.ResultsThe 24-valent pneumococcal conjugate vaccine prevented fewer pneumococcal disease cases and deaths than the recently recommended 21-valent pneumococcal conjugate vaccine, which is formulated on the basis of adult pneumococcal disease serotypes. In cost-effectiveness analyses, 21-valent pneumococcal conjugate vaccine was economically favorable compared with 24-valent pneumococcal conjugate vaccine and all other vaccination strategies, both without and with consideration of potential childhood vaccination indirect effects. These findings were robust and consistent with those in deterministic and probabilistic sensitivity analyses.ConclusionsIn older adults, 24-valent pneumococcal conjugate vaccine was clinically and economically unfavorable compared with 21-valent pneumococcal conjugate vaccine, which covers more adult disease-causing pneumococcal serotypes and is less susceptible to childhood vaccination indirect effects.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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