Cost-effectiveness of Pneumococcal Vaccination Among Patients With CKD in the United States.

RATIONALE & OBJECTIVE: Pneumococcal vaccine is recommended for adults 65 years and older and those younger than 65 years with clinical indications (eg, diabetes, lung/heart disease, kidney failure, and nephrotic syndrome). Its cost-effectiveness in less severe chronic kidney disease (CKD) is uncharacterized.

STUDY DESIGN: Cost-effectiveness analysis.

SETTING & POPULATION: US adults aged 50 to 64 and 65 to 79 years stratified by CKD risk status: no CKD (estimated glomerular filtration rate≥60mL/min/1.73m and urinary albumin-creatinine ratio

INTERVENTION(S): Vaccination compared to no vaccination.

OUTCOMES: Incremental cost-effectiveness ratios based on US dollars per quality-adjusted life-year (QALY).

MODEL, PERSPECTIVE, & TIMEFRAME: Markov model, US health sector perspective, and lifetime horizon.

RESULTS: The prevalence of pneumococcal vaccination in NHANES 1999 to 2004 was 56.6% (aged 65-79 years), 28.5% (aged 50-64 years with an indication), and 9.7% (aged 50-64 years without an indication), with similar prevalences across CKD risk status. Pneumococcal vaccination was overall cost-effective (

LIMITATIONS: Some model parameters were based on data from the general population. Analysis did not consider costs associated with kidney disease progression.

CONCLUSIONS: Uptake of pneumococcal vaccination should be improved in general. Our results also suggest the cost-effectiveness of expanding its indication to younger adults with CKD less severe than kidney failure or nephrotic syndrome.