OBJECTIVES: This study aimed to understand the value of current and expanded vaccination programs against 4 preventable diseases in older adults in the US, accounting for population aging.
METHODS: Cost-benefit analyses were conducted using an underlying population-based, age-structured economic model. This model used annual census projections for adults aged 50 years and older and separate decision trees for influenza, pertussis, herpes zoster, and pneumococcal disease to calculate cases of disease and direct medical and indirect costs (2017 US$). Age- and disease-specific incidence and costs were assumed constant over time. Benefit-cost ratios (BCRs) and net present values (NPVs) were calculated to compare the current vaccination program vs. no vaccination program. Scenario analyses were conducted over multiple time horizons, discount rates, and vaccine coverage and effectiveness assumptions.
RESULTS: Compared with no vaccination program, the model projects that the current adult vaccination program is associated with 64.5 million averted cases of disease, $243.5 billion averted costs of cases, and $172.2 billion in incremental vaccination costs over a 30-year period from a societal perspective. For all 4 diseases combined, the resulting NPV is $71.3 billion (BCR = 1.41). Results vary by disease, with NPVs ranging from $144.9 million (pertussis) to $47.6 billion (pneumococcal) and BCRs ranging from 1.11 (influenza) to 2.95 (pneumococcal). In a scenario with increased vaccine coverage vs. current vaccine coverage for all 4 diseases, the projected societal NPV is $13.9 billion (BCR = 1.14) over a 30-year period. The projected NPV is $22.4 billion for a scenario of increased efficacy for influenza and tetanus-diphtheria-pertussis (Tdap) vaccines (BCR = 1.22).
CONCLUSIONS: The results from the cost-benefit analyses highlight the value of the adult vaccination program in the US. Additionally, the study suggests that efforts to further increase vaccination rates and vaccine efficacy in older adults may be warranted and economically justifiable.
