Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands

Dominic Thorrington, Leo Van Rossum, Mirjam Knol, Hester De Melker, Hans Rümke, Eelko Hak, Albert Jan Van Hoek*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    32 Citations (Scopus)


    Background Streptococcus pneumoniae causes morbidity and mortality among all ages in The Netherlands. To reduce this burden, infants in The Netherlands receive the 10-valent pneumococcal conjugated vaccine (PCV10), but older persons are not targeted. We assessed the impact and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) or 13-valent PCV (PCV13) among all those aged 60, 65 or 70 and/or in combination with replacing PCV10 with PCV13 in the infant vaccination programme. Methods A static cost-effectiveness model was parameterized including projected trends for invasive pneumococcal disease (IPD) and hospitalised community acquired pneumonia (CAP). The different strategies were evaluated using vaccine list prices and a 10-year time horizon. Incremental cost-effectiveness ratios (ICER) were calculated with the current strategy (infant vaccination program with PCV10) as reference. Results Compared to the reference, the largest impact on pneumococcal disease burden was projected with a combined use of PCV13 among infants and PPV23 at 60, 65 and 70 years, preventing 1,635 cases of IPD and 914 cases of CAP. The most cost-effective strategy was vaccinating with PPV23 at 70 years only with similar low ICERs at age 60 and 65. The impact of the use of PCV13 among infants depends strongly on the projected herd-immunity effect on serotype 19A. Vaccinating elderly with either PCV13 or PPV23 was dominated by PPV23 in all investigated scenarios, mainly due to the lower price of PPV23. Conclusion Under the current assumptions, the best value for money is the use of PPV23 for elderly, with a single dose or at five year increment between age 60 to age 70.

    Original languageEnglish
    Article numbere0192640
    JournalPLoS ONE
    Issue number2
    Publication statusPublished - Feb 2018

    Bibliographical note

    Funding Information:
    DM was funded by I-Move+, a H2020 grant (#634446) from the European Council (http://; AJvH was funded by National Institute for Health Research Health Protection Research Unit (NIHR HPRU #HPRU-2012-10096) in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England (PHE) ( The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the EU H2020, the Netherlands National Institute for Public Health and the Environment, the Dutch Health Council, the London School of Hygiene & Tropical Medicine, the Department of Health or Public Health England. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Publisher Copyright:
    © 2018 Thorrington et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Copyright 2018 Elsevier B.V., All rights reserved.


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