Alternative strategies for adult pneumococcal polysaccharide vaccination: a cost- effectiveness analysis Smith K J, Zimmerman R K, Lin C J, Nowalk M P, Ko F S, McEllistrem M C, Roberts M S Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The study examined the cost-effectiveness of alternative strategies for pneumococcal polysaccharide vaccination to prevent invasive pneumococcal disease in adults. The authors concluded that vaccination at ages 50 and 65 years would be more cost-effective than the current vaccination policy (vaccination at age 65 and younger with co-morbidities). The study methodology was characterised by a lack of information on the sources used to derive the economic data. Nevertheless, the extensive use of sensitivity analysis and the clear presentation of study findings enhance the validity of the authors' conclusions. Type of economic evaluation Cost-utility analysis Study objective The objective of the study was to examine the cost-effectiveness of alternative strategies for pneumococcal polysaccharide vaccination (PPV) to prevent invasive pneumococcal disease (IPD) in adults aged 50 years or older. Interventions Eight PPV strategies were considered. These were no vaccination, one vaccination (at age 50 or 65), two vaccinations (at ages 50/65 or 65/80), three vaccinations (at ages 50/65/80), four vaccinations (at ages 50/60/70/80), and a strategy depicting present US adult vaccination policy (vaccination at age 65 years unless a co-morbid condition is diagnosed prior to that age). Location/setting USA/primary care. Methods Analytical approach: A Markov model was developed in order to simulate the natural history of disease and to determine the clinical and economic impact of the alternative immunisation strategies on the basis of epidemiological and clinical data from the published literature. A lifetime horizon was considered. The authors stated that a societal perspective was adopted. Effectiveness data: The clinical data appear to have been derived from a selection of known relevant studies. Details of a review of the literature were not reported. Epidemiological data and transition probabilities to chronic health states were derived from the 2004 National Health Interview Survey, supported by data from Surveillance, Epidemiology and End Results programme and the Framingham Study. Other national databases, such as the CDC Active Bacterial Core surveillance publications, were also used. Vaccine effectiveness was derived using data obtained from a modified Delphi panel, which supplied ranges of values (minimum and maximum estimates). This represented the key clinical input of the model. Monetary benefit and utility valuations: Utility valuations were derived from the literature, but no other details were given. Measure of benefit: NHS Economic Evaluation Database (NHS EED) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 4