{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:42:19Z","timestamp":1791538939198,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI11657503"],"award-info":[{"award-number":["R01 AI11657503"]}],"id":[{"id":"10.13039\/100000060","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":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost\u2010effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov model compared no vaccination and current recommendations (either 20\u2010valent pneumococcal conjugate vaccine [PCV20] alone or 15\u2010valent pneumococcal conjugate vaccine plus the 23\u2010valent pneumococcal polysaccharide vaccine [PCV15\/PPSV23]) without or with programs to increase vaccine uptake in Black and non\u2010Black 65\u2010year\u2010old cohorts. Pre\u2010pandemic population\u2010 and serotype\u2010specific pneumococcal disease risk and illness\/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine\u2010eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%\/year over a lifetime time horizon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality\u2010adjusted life year (QALY) gained compared with no vaccination; incremental cost\u2010effectiveness was $245,546\/QALY for PCV20 with program and $425,264\/QALY for PCV15\/PPSV23 with program. In non\u2010Black cohorts, all strategies cost &gt;$200,000\/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds &lt;$200,000\/QALY gained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19031","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T07:23:00Z","timestamp":1717226580000},"page":"2423-2433","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Changes in the cost\u2010effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-0161","authenticated-orcid":false,"given":"Angela R.","family":"Wateska","sequence":"first","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-2690","authenticated-orcid":false,"given":"Mary Patricia","family":"Nowalk","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8345-4048","authenticated-orcid":false,"given":"Shoroq M.","family":"Altawalbeh","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"},{"name":"Jordan University of Science and Technology Faculty of Pharmacy  Irbid Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9441-3508","authenticated-orcid":false,"given":"Chyongchiou J.","family":"Lin","sequence":"additional","affiliation":[{"name":"Martha S. Pitzer Center for Women, Children and Youth The Ohio State University College of Nursing  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3787-2705","authenticated-orcid":false,"given":"Lee H.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-8078","authenticated-orcid":false,"given":"William","family":"Schaffner","sequence":"additional","affiliation":[{"name":"Department of Health Policy Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5941-6092","authenticated-orcid":false,"given":"Richard K.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8088-566X","authenticated-orcid":false,"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Family Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,1]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"College of Physicians of Philadelphia.History of Vaccines: Pneumonia (Pneumococcal Disease).https:\/\/historyofvaccines.org\/diseases\/pneumonia-pneumococcal-diseaseAccessed May 2023."},{"key":"e_1_2_10_3_1","unstructured":"National Center for Immunization and Respiratory Diseases.Centers for Disease Control and Prevention. 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