Pneumococcal vaccination is a cost-effective intervention for adults with chronic kidney disease (CKD) under age 65, in the absence of other clinical indications, reports a study in the American Journal of Kidney Diseases.
Using data from the National Health and Nutrition Examination Survey 1999 to 2004, the researchers estimated the prevalence of pneumococcal vaccination among patients with CKD, based on age and clinical indications. For patients aged 65 to 79–for whom the vaccine is indicated by age–vaccination prevalence was 56.6%. For CKD patients aged 50 to 64, prevalence was 28.5% for those with clinical indications (such as diabetes, lung or heart disease, kidney failure, and nephrotic syndrome) and 9.7% for those without indications.
Forty-one percent of the younger CKD patients had clinical indications, most commonly lung disease. The prevalence of vaccination did not differ significantly by CKD risk status.
The cost of pneumococcal vaccination was higher and effectiveness was lower in older adults and in patients with higher CKD risk status. Based on a willingness-to-pay threshold of $100,000 per quality-adjusted cost year (QALY), vaccination was cost-effective in CKD patients aged 50 to 64 ($38,000/QALY) and in those aged 65 to 79 ($15,000/QALY).
In the younger group, incremental cost-effectiveness ratio increased from $1000/QALY for patients with kidney failure or nephrotic-range albuminuria, to $17,000/QALY for CKD with high risk, to $25,000/QALY for CKD with moderate risk, to $43,000/QALY for those without CKD. Sensitivity analysis suggested that vaccination for younger patients was cost-effective even at lower vaccine efficacy or 50% higher cost.