Indirect costs of adult pneumococcal disease and productivity-based rate of return to PCV13 vaccination for older adults and elderly diabetics in Denmark

Abstract

Objectives

To assess vaccines, HTAs should consider their broader socioeconomic effects, including those on market and nonmarket productivity (indirect costs, ICs). They should also consider decision criteria beyond cost-effectiveness that incorporate such effects, like social rates of return (RoR). We develop a method for measuring vaccination’s productivity benefits and social RoR and apply it to the case of PCV13 in older Danish adults.

Methods

We measure ICs from death and disability per treatment episode of inpatient community-acquired pneumonia (ICAP), outpatient CAP (OCAP), bacteremia, and meningitis in Danes aged 50–85. Losses include market and nonmarket work (housework, caregiving, and volunteering time valued at the unskilled wage), and span the duration of disability or, with death, the rest of life with background mortality risks. We calculate a RoR to PCV13 Adult in terms of averted direct costs (DCs) and ICs, allowing for herd effects and serotype replacement from child vaccination. We perform separate calculations for diabetics aged 65–85. We use data from EuroStat, Statistics Denmark, Danish prices/charges, and the published literature.

Results

ICs per episode exceed per capita GDP (PCGDP) for ICAP, approach PCGDP for bacteremia, exceed five times PCGDP for meningitis, and exceed 20 times DCs for OCAP. ICs consist largely of nonmarket productivity—specifically housework—lost to death. The RoR to PCV13 in the general older adult population is 149% and is driven by averted ICAP-related costs. In elderly diabetics, ICs per episode are higher and the RoR a stunning 1,191%. Main results are robust in sensitivity analyses.

Conclusions

The ICs of pneumococcal disease are considerable, even among older retired adults. The RoR to PCV13 in Danish older adults is high, especially for elderly diabetics, and compares very favorably with that of highly-regarded development interventions. Failing to account for productivity in valuing vaccination can result in considerable undervaluation.