Cost-effectiveness of Pneumococcal Vaccination Among Patients With CKD in the United States

Abstract

Rationale & objective: Pneumococcal vaccine is recommended for adults 65 years and older and those younger than 65 years with clinical indications (eg, diabetes, lung/heart disease, kidney failure, and nephrotic syndrome). Its cost-effectiveness in less severe chronic kidney disease (CKD) is uncharacterized.

Study design: Cost-effectiveness analysis.

Setting & population: US adults aged 50 to 64 and 65 to 79 years stratified by CKD risk status: no CKD (estimated glomerular filtration rate≥60mL/min/1.73m² and urinary albumin-creatinine ratio<30mg/g), CKD with moderate risk, CKD with high risk, and kidney failure (estimated glomerular filtration rate<15mL/min/1.73m²) or nephrotic-range albuminuria (urinary albumin-creatinine ratio≥2,000mg/g). Data sources were the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, Centers for Disease Control and Prevention, and the Atherosclerosis Risk in Communities (ARIC) Study.

Intervention(s): Vaccination compared to no vaccination.

Outcomes: Incremental cost-effectiveness ratios based on US dollars per quality-adjusted life-year (QALY).

Model, perspective, & timeframe: Markov model, US health sector perspective, and lifetime horizon.

Results: The prevalence of pneumococcal vaccination in NHANES 1999 to 2004 was 56.6% (aged 65-79 years), 28.5% (aged 50-64 years with an indication), and 9.7% (aged 50-64 years without an indication), with similar prevalences across CKD risk status. Pneumococcal vaccination was overall cost-effective (<US $100,000/QALY) for adults aged 65 to 79 years (US $15,000/QALY) and 50 to 64 years (US $38,000/QALY). Among those aged 50 to 64 years, incremental cost-effectiveness ratios were lowest for kidney failure or nephrotic-range albuminuria (US $1,000/QALY), followed by CKD with high risk (US $17,000/QALY), CKD with moderate risk (US $25,000/QALY), and no CKD (US $43,000/QALY). Pneumococcal vaccination was cost-effective among adults aged 50 to 64 years with CKD even when assuming the lowest vaccine efficacy or 50% higher vaccine costs.

Limitations: Some model parameters were based on data from the general population. Analysis did not consider costs associated with kidney disease progression.

Conclusions: Uptake of pneumococcal vaccination should be improved in general. Our results also suggest the cost-effectiveness of expanding its indication to younger adults with CKD less severe than kidney failure or nephrotic syndrome.

Keywords: Chronic kidney disease (CKD); albuminuria; chronic kidney failure; chronic renal insufficiency; cost-effectiveness; glomerular filtration rate (GFR); infection; infectious disease; invasive pneumococcal disease; pneumococcal disease; pneumococcal pneumonia; pneumococcal vaccine; proteinuria; streptococcus pneumonia; vaccination.