Abstract
Background Higher-valency pneumococcal conjugate vaccines (PCVs) may reduce the burden of adult pneumococcal disease (PD), yet it is unclear whether higher acquisition costs are offset by improved health outcomes and cost savings.Research design and methods A published state-transition Markov model simulated vaccine-naïve adults aged ≥60 years stratified by risk group and followed until death or a maximum age of 100 years was adapted to compare PCV21 versus PCV20. Published epidemiological and cost data were used to populate the model. Costs and quality-adjusted life years were discounted annually at 3%, and costs were expressed in 2024 Euros. Deterministic and probabilistic sensitivity analyses were conducted. A scenario analysis evaluated the effect of reducing the NBPP disease coverage difference (PCV21-PCV20).Results Compared with PCV20, PCV21 reduced PD-related cases, deaths, direct medical costs, and indirect costs. From both the payer and societal perspectives, PCV21 was cost-saving compared with PCV21. In the sensitivity analysis, PCV21 remained cost-saving across all parameter variations and willingness-to-pay thresholds evaluated. In scenario analysis, PCV21 became dominated when the NBPP disease coverage difference decreased to 0.5%.Conclusion PCV21 may provide greater health and economic benefits than PCV20 for adult pneumococcal vaccination in Germany, remaining cost-saving across a range of model inputs and scenarios.