Vaccine
Volume 27, Issue 24, Pages 3127-3238 (21 May 2009)
http://www.sciencedirect.com/science/journal/0264410X

Age, revaccination, and tolerance effects on pneumococcal vaccination strategies in the elderly: A cost-effectiveness analysis
Pages 3159-3164
Kenneth J. Smith, Richard K. Zimmerman, Mary Patricia Nowalk, Mark S. Roberts
Abstract
Optimal pneumococcal polysaccharide vaccination (PPV) policy is unknown for cohorts aged ≥65 years. Using a Markov model, we estimated the cost-effectiveness of single- and multiple-dose PPV strategies in 65-, 75-, and 80-year-old cohorts. PPV at age 65 cost $26,100 per QALY (quality adjusted life years) gained. Vaccination at ages 75 and 80 cost $71,300–75,800 per QALY; revaccination strategies cost more. When prior vaccination and loss of vaccine effectiveness due to tolerance are assumed, cost-effectiveness ratios increase substantially. Single-dose PPV is worth considering in patients aged 65–80 from clinical and economic standpoints. Revaccination strategies for the elderly are less cost-effective, particularly when prior vaccination and vaccine tolerance are considered.