Higher-Valent Pneumococcal Conjugate Vaccines More Cost-Effective in Adult Populations

A systematic review and meta-analysis showed higher-valent pneumococcal conjugate vaccines (PCVs) are cost-effective in many adult settings and populations compared with lower-valent vaccines and the 23-valent pneumococcal polysaccharide vaccine (PPSV23).

The results were especially true in higher-income countries and from a health care perspective, affirming the role of higher-valent vaccines in pneumococcal prevention efforts in adults.¹

Why is Assessing Cost-Effectiveness Important?

PCVs have increasingly grown in valency since their introduction in 2000. Accordingly, there has been a significant decline in vaccine-type pneumococcal disease, transforming the landscape of childhood immunizations and protecting both children and adults against a range of pneumococcal infections. Today, a series of PCVs is in use and recommended for various populations in the United States.^2,3

The CDC recommends that children aged younger than 5 and adults aged 50 and older receive a pneumococcal vaccination, along with adults at increased risk for pneumococcal disease. Numerous PCVs, including 15-valent PCV (PCV15), 20-valent PCV (PCV20), and 21-valent PCV (PCV21) are licensed in the United States for use in various populations. PPSV23 is also used for catch-up and booster dosing. With many available options, assessing the cost-effectiveness of these vaccines is critical for optimal utilization.³

Cost-effectiveness analysis (CEA) studies are essential for supporting evidence-based decision-making with vaccines by helping identify and compare activities with the necessary sustainability to optimize public health. Concurrently, meta-analysis of economic evaluations (MAEEs) has been introduced as a method to systematically compare findings across studies. Using these 2 study designs, the investigators sought to estimate the incremental net benefits (INBs) and assess the cost-effectiveness of higher-valent PCVs in adults.^1,4

Primarily, the authors aimed to calculate the INB of higher-valent pneumococcal vaccines for adults. In total, 26 studies met the criteria for review inclusion, with one other recently published study on PCV21 identified through manual search, meaning 27 studies were included. All studies were published since 2022 onward, and most of the economic evaluations were conducted in high-income countries.

Are Higher-Valent Pneumococcal Vaccines More Cost Effective?

For individuals aged 18 and older, PCV20 demonstrated statistically significant cost-effectiveness over PCV15 + PSV23 (INB = 19.3 [95% CI, 14.2—24.4]) and PPSV23 (INB = 269.3 [95% CI, 96.4—442.1]). Furthermore, point estimates suggested superior—not not significant—effectiveness of PCV20 relative to PCV13 + PPSV23 and no vaccination. From a societal perspective, a pooled analysis indicated significant cost-effectiveness of PCV20 versus PPSV23 (INB = 354.3 [95% CI, 92.9—615.7]).¹

Shifting to adults aged 50 and older, only 2 studies assessed cost effectiveness, centered around PCV15 and PPSV23. The authors found that PCV15 + PPSV23 versus no vaccination was significantly more cost-effective in this population (INB = 80.1 [95% CI, 39.6—120.6]), indicating the benefits of immunization among working-age adults due to the prevention of productivity loses.¹

The authors also assessed adults aged 60 and older from both health care and societal perspectives. Across included studies, PCV20 consistently demonstrated superior cost-effectiveness compared with alternative strategies. Pooled INBs for PCV20 were 44.3 (95% CI, 21.1—67.4) compared with PCV15 + PPSV23, 37.5 (95% CI, 28.0—47.0) compared with PCV15, and 161.2 (95% CI, 3.5–318.9) compared with PPSV23. From a societal perspective, only PCV15+ PPSV23 was evaluated against no vaccination, indicating little cost-effectiveness, likely due to reduced productivity gains following retirement.¹

These data reflect the cost-effectiveness of higher-valent PCVs and the advantages they offer compared with lower-valent vaccines. Given the immense burden of pneumococcal disease even beyond clinical complications, including increased medical expenditures, productivity loses, and the need for informal caregiving, it is critical to proliferate higher-valent vaccines when feasible to patients seeking pneumococcal vaccination.

“This quantitative synthesis of CEA results could offer consolidated evidence to guide policy decisions and support the adoption of higher-valent PCVs in adult immunization programs,” the study authors concluded. “Further research that integrates standardized societal perspectives and real-world effectiveness data is needed to capture the broader implications of higher-valent PCVs.”¹

REFERENCES

1. Lee H, Cho J, Vietri J, Dawson E, Chaiyakunapruk N. The incremental net monetary benefit of higher-valent pneumococcal conjugate vaccines for adults: a systematic review and meta-analysis of economic evaluations. J Med Econ. 2025;28(1):1761-1778. doi:10.1080/13696998.2025.2565902

2. Vo NX, Pham HL, Bui UM, Ho HT, B TT. Cost-effectiveness analysis of pneumococcal vaccines in the pediatric population: A systematic review. Healthcare. 2024;12(19):1950. doi:10.3390/healthcare12191950

3. Pneumococcal—Pneumococcal vaccine recommendations. CDC. Updated October 26, 2024. Accessed October 13, 2025. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html

4. Rabarison KM, Bish CL, Massoudi MS, Giles WH. Economic evaluation enhances public health decision making. Front Public Health. 2015;3(164). doi:10.3389/fpubh.2015.00164