TY - JOUR
T1 - Cost-effectiveness of Pneumococcal Vaccination Among Patients With CKD in the United States
AU - Ishigami, Junichi
AU - Padula, William V.
AU - Grams, Morgan E.
AU - Chang, Alexander R.
AU - Jaar, Bernard
AU - Gansevoort, Ron T.
AU - Bridges, John F.P.
AU - Kovesdy, Csaba P.
AU - Uchida, Shinichi
AU - Coresh, Josef
AU - Matsushita, Kunihiro
N1 - Publisher Copyright:
© 2019
PY - 2019/7
Y1 - 2019/7
N2 - 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 ≥ 60 mL/min/1.73 m2 and urinary albumin-creatinine ratio < 30 mg/g), CKD with moderate risk, CKD with high risk, and kidney failure (estimated glomerular filtration rate < 15 mL/min/1.73 m2) or nephrotic-range albuminuria (urinary albumin-creatinine ratio ≥ 2,000 mg/g). Data sources were the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, Centers for Disease Control and Prevention, and the Atherosclerosis Risk in Communities (ARIC) Study. 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 (<US $100,000/QALY) for adults aged 65 to 79 years (US $15,000/QALY) and 50 to 64 years (US $38,000/QALY). Among those aged 50 to 64 years, incremental cost-effectiveness ratios were lowest for kidney failure or nephrotic-range albuminuria (US $1,000/QALY), followed by CKD with high risk (US $17,000/QALY), CKD with moderate risk (US $25,000/QALY), and no CKD (US $43,000/QALY). Pneumococcal vaccination was cost-effective among adults aged 50 to 64 years with CKD even when assuming the lowest vaccine efficacy or 50% higher vaccine costs. 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.
AB - 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 ≥ 60 mL/min/1.73 m2 and urinary albumin-creatinine ratio < 30 mg/g), CKD with moderate risk, CKD with high risk, and kidney failure (estimated glomerular filtration rate < 15 mL/min/1.73 m2) or nephrotic-range albuminuria (urinary albumin-creatinine ratio ≥ 2,000 mg/g). Data sources were the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, Centers for Disease Control and Prevention, and the Atherosclerosis Risk in Communities (ARIC) Study. 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 (<US $100,000/QALY) for adults aged 65 to 79 years (US $15,000/QALY) and 50 to 64 years (US $38,000/QALY). Among those aged 50 to 64 years, incremental cost-effectiveness ratios were lowest for kidney failure or nephrotic-range albuminuria (US $1,000/QALY), followed by CKD with high risk (US $17,000/QALY), CKD with moderate risk (US $25,000/QALY), and no CKD (US $43,000/QALY). Pneumococcal vaccination was cost-effective among adults aged 50 to 64 years with CKD even when assuming the lowest vaccine efficacy or 50% higher vaccine costs. 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.
KW - Chronic kidney disease (CKD)
KW - albuminuria
KW - chronic kidney failure
KW - chronic renal insufficiency
KW - cost-effectiveness
KW - glomerular filtration rate (GFR)
KW - infection
KW - infectious disease
KW - invasive pneumococcal disease
KW - pneumococcal disease
KW - pneumococcal pneumonia
KW - pneumococcal vaccine
KW - proteinuria
KW - streptococcus pneumonia
KW - vaccination
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U2 - 10.1053/j.ajkd.2019.01.025
DO - 10.1053/j.ajkd.2019.01.025
M3 - Article
C2 - 30898360
AN - SCOPUS:85062976731
SN - 0272-6386
VL - 74
SP - 23
EP - 35
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -