{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T20:37:10Z","timestamp":1771187830306,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T00:00:00Z","timestamp":1582329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI11657503"],"award-info":[{"award-number":["R01 AI11657503"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND\/OBJECTIVES<\/jats:title>\n                    <jats:p>Recently revised vaccination recommendations for US adults, aged 65\u2009years and older, include both 23\u2010valent pneumococcal polysaccharide vaccine (PPSV23) and 13\u2010valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost\u2010effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Markov decision analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING AND PARTICIPANTS<\/jats:title>\n                    <jats:p>Hypothetical 65\u2010year\u2010old general and black population cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>INTERVENTION<\/jats:title>\n                    <jats:p>Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The current pneumococcal vaccination recommendation was the most effective strategy, but afforded slight public health benefits compared to an alternative (PPSV23 for all older people plus PCV13 for the immunocompromised) and cost greater than $750 000 per quality\u2010adjusted life\u2010year (QALY) gained in either population group with a vaccine uptake improvement program (absolute uptake increase = 12.3%; cost = $1.78\/eligible patient) in place. The alternative strategy was more economically favorable, but cost greater than $100 000\/QALY in either population, with or without an uptake intervention. Results were robust in sensitivity analyses; however, in black older people, the alternative strategy with an uptake program was most likely to be favored in probabilistic sensitivity analyses at a $150 000\/QALY gained threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Current pneumococcal vaccination recommendations for US older people are economically unfavorable compared to an alternative strategy omitting PCV13 in the immunocompetent. The alternative recommendation with an uptake improvement program may be economically reasonable in black population analyses and could be worth considering as a population\u2010wide recommendation if mitigating racial disparities is a priority. J Am Geriatr Soc 68:1271\u20131278, 2020.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16373","type":"journal-article","created":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T08:14:46Z","timestamp":1582359286000},"page":"1271-1278","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cost\u2010Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations"],"prefix":"10.1111","volume":"68","author":[{"given":"Angela R.","family":"Wateska","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Patricia","family":"Nowalk","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chyongchiou J.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee H.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Schaffner","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Vanderbilt University School of Medicine  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard K.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8088-566X","authenticated-orcid":false,"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,22]]},"reference":[{"issue":"37","key":"e_1_2_6_2_1","first-page":"822","article-title":"Use of 13\u2010valent pneumococcal conjugate vaccine and 23\u2010valent pneumococcal polysaccharide vaccine among adults aged \u226565\u2009years: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"63","author":"Tomczyk S","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_6_3_1","unstructured":"MatanockA.Considerations for PCV13 use among adults >65\u2009years old and a summary of the evidence to recommendations framework. 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