{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:41:20Z","timestamp":1793320880492,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pfizer Italia"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>The availability of a new 20-valent pneumococcal conjugate vaccine (PCV) makes it appropriate to assess its cost-effectiveness. This was evaluated by adopting the Italian National Health Service perspective, using a cost consequences Markovian model. The expected effects of vaccination with 20-valent PCV were compared with the administration of 13-valent PCV and 15-valent PCV. Assuming a 100% vaccination of cohorts aged 65\u201374 years, in the (lifetime) comparison between 20-valent PCV and 13-valent PCV, the former is dominant (lower cost for a better health outcome). A reduction in disease events was estimated: \u22121208 deaths; \u22121171 cases of bacteraemia; \u2212227 of meningitis; \u22129845 hospitalised all-cause nonbacteremic pneumonia cases (NBP) and \u221221,058 non-hospitalised. Overall, in the Italian population, a total gain of 6581.6 life years and of 4734.0 QALY was estimated. On the cost side, against an increase in vaccinations costs (EUR +40.568 million), other direct health costs are reduced by EUR 48.032 million, with a net saving of EUR +7.464 million. The comparison between 20-valent PCV and 15-valent PCV results in an Incremental Cost-Effectiveness Ratio (ICER) of EUR 66 per life year gained and EUR 91 per QALY gained. The sensitivity analyses confirm the robustness of the results. We can conclude that the switch to 20-valent PCV is a sustainable and efficient investment.<\/jats:p>","DOI":"10.3390\/vaccines10122032","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T04:31:16Z","timestamp":1669609876000},"page":"2032","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cost-Effectiveness of Vaccination with the 20-Valent Pneumococcal Conjugate Vaccine in the Italian Adult Population"],"prefix":"10.3390","volume":"10","author":[{"given":"Barbara","family":"Polistena","sequence":"first","affiliation":[{"name":"C.R.E.A. Sanit\u00e0, Roma and University of Roma \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-8487","authenticated-orcid":false,"given":"Giancarlo","family":"Icardi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DISSAL), IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-9610","authenticated-orcid":false,"given":"Andrea","family":"Orsi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences (DISSAL), IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-2850","authenticated-orcid":false,"given":"Federico","family":"Spandonaro","sequence":"additional","affiliation":[{"name":"C.R.E.A. Sanit\u00e0, University San Raffaele, 00166 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Di Virgilio","sequence":"additional","affiliation":[{"name":"Pfizer Italia s.r.l., 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"d\u2019Angela","sequence":"additional","affiliation":[{"name":"C.R.E.A. 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Rapporto 2020."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4587","DOI":"10.1016\/j.vaccine.2017.07.010","article-title":"Impact of pneumococcal conjugate vaccine (PCV7 and PCV13) on pneumococcal invasive diseases in Italian children and insight into evolution of pneumococcal population structure","volume":"35","author":"Camilli","year":"2017","journal-title":"Vaccine"},{"key":"ref_5","unstructured":"(2022, June 28). Sierotipi di Pneumococco in Italia. Available online: https:\/\/www.epicentro.iss.it\/infettive\/SierotipiPneumococco."},{"key":"ref_6","unstructured":"(2022, June 28). Factsheet about Pneumococcal Disease. Available online: https:\/\/www.ecdc.europa.eu\/en\/pneumococcal-disease\/facts."},{"key":"ref_7","first-page":"62","article-title":"Le infezioni pneumococciche dell\u2019adulto in Italia e le possibilit\u00e0 di prevenzione. Quale ruolo per i nuovi vaccini coniugati?","volume":"2","author":"Moriondo","year":"2012","journal-title":"Riv. Soc. Ital. Med. Gen."},{"key":"ref_8","unstructured":"da Pneumococco, I. (2022, June 28). Msd Manuals. Available online: https:\/\/www.msdmanuals.com\/it-it\/professionale\/malattie-infettive\/cocchi-gram-positivi\/infezioni-da-pneumococco."},{"key":"ref_9","unstructured":"(2022, June 28). Pneumococcal Disease, Available online: https:\/\/www.cdc.gov\/vaccines\/pubs\/pinkbook\/pneumo.html#streptococcus-pneumoniae."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e361","DOI":"10.1097\/MJT.0000000000000551","article-title":"Antimicrobial Resistant Streptococcus pneumoniae: Prevalence, Mechanisms, and Clinical Implications","volume":"24","author":"Cherazard","year":"2017","journal-title":"Am. J. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.3390\/ijms17071140","article-title":"Pneumococcus and the elderly in Italy: A summary of available evidence regarding carriage, clinical burden of lower respiratory tract infections and on-field effectiveness of PCV13 vaccination","volume":"17","author":"Orsi","year":"2016","journal-title":"Int. J. Mol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e019034","DOI":"10.1136\/bmjopen-2017-019034","article-title":"Effectiveness of the 13-valent pneumococcal conjugate vaccine against adult pneumonia in Italy: A case-control study in a 2-year prospective cohort","volume":"8","author":"Prato","year":"2018","journal-title":"BMJ Open"},{"key":"ref_13","unstructured":"(2022, June 28). Apexxnar Epar Product Information. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/apexxnar-epar-product-information_it.pdf."},{"key":"ref_14","unstructured":"Center for Disease Control and Prevention (2018). National Health Interview Survey, Prevention CfDCa."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6470","DOI":"10.1016\/j.vaccine.2010.07.037","article-title":"Prevalence of high-risk indications for influenza vaccine varies by age, race, and income","volume":"28","author":"Zimmerman","year":"2010","journal-title":"Vaccine"},{"key":"ref_16","unstructured":"della Salute, M. (2020). Schede di Dimissione Ospedaliera, ISS."},{"key":"ref_17","unstructured":"Center for Disease Control and Prevention (2020). Active Bacterial Core Surveillance (ABCs), Report Emerging Infections Program Network Streptococcus pneumoniae 2018."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4947","DOI":"10.1016\/j.vaccine.2008.07.016","article-title":"Impact of the introduction of pneumococcal conjugate vaccine on rates of community acquired pneumonia in children and adults","volume":"26","author":"Nelson","year":"2008","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Weycker, D., Farkouh, R.A., Strutton, D.R., Edelsberg, J., Sato, R., and Jackson, L.A. (2016). Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1432-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.3390\/vaccines9121380","article-title":"Economic burden of pneumococcal disease in individuals aged 15 years and older in the Liguria region of Italy","volume":"9","author":"Astengo","year":"2021","journal-title":"Vaccines"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Orsi, A., Domnich, A., Mosca, S., Ogliastro, M., Sticchi, L., Prato, R., Martinelli, D., Fortunato, F., Vitale, F., and Tramuto, F. (2022). Prevalence of pneumococcal serotypes in community-acquired pneumonia among older adults in Italy\u2014A multicenter cohort study. Clin. Microbiol. Infect., forthcoming.","DOI":"10.3390\/microorganisms11010070"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"699","DOI":"10.4161\/hv.23268","article-title":"Cost-effectiveness of new adult pneumococcal vaccination strategies in Italy","volume":"9","author":"Boccalini","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"960","DOI":"10.7326\/0003-4819-138-12-200306170-00007","article-title":"Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race","volume":"138","author":"Sisk","year":"2003","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mangen, M.-J.J., Huijts, S.M., Bonten, M.J.M., and de Wit, G.A. (2017). The impact of community-acquired pneumonia on the health-related quality-of-life in elderly. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2302-3"},{"key":"ref_25","unstructured":"Servizio Sanitario Regione Emilia Romagna (2019). Tariffario Vaccinazioni, AUSL Imola."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1056\/NEJMoa1408544","article-title":"Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults","volume":"372","author":"Bonten","year":"2015","journal-title":"NEJM"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1183\/13993003.00325-2015","article-title":"Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands","volume":"46","author":"Mangen","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1056\/NEJMoa035060","article-title":"A Trial of a 9-Valent Pneumococcal Conjugate Vaccine in Children with and Those without HIV Infection","volume":"349","author":"Klugman","year":"2003","journal-title":"NEJM"},{"key":"ref_29","unstructured":"AIFA (2022, June 28). OSMED Interattivo, Available online: https:\/\/www.aifa.gov.it\/osmed-interattivo."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1080\/21645515.2017.1264827","article-title":"Economic studies applied to vaccines against invasive diseases: An updated budget","volume":"13","author":"Boccalini","year":"2017","journal-title":"Hum. Vaccines Immunother."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/12\/2032\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:28:13Z","timestamp":1760146093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/12\/2032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,28]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["vaccines10122032"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10122032","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,28]]}}}