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 >= 60 mL/min/1.73 m(2) and urinary albumincreatinine ratio <30 mg/g), CKD with moderate risk, CKD with high risk, and kidney failure (estimated glomerular filtration rate <15 mL/min/1.73 m(2)) 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 5064 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.