Cost-utility of pneumococcal strategies for adults aged 50 and older in Colombia: a model-based economic evaluation

Pneumococcal disease remains a significant cause of morbidity, mortality, and healthcare costs among older adults in Colombia. High-valency conjugate vaccines, such as PCV20, may offer broader serotype coverage and greater clinical benefits than existing strategies; however, a local economic evaluation is required to determine their cost-effectiveness. A decision-tree model simulated a cohort of healthy adults aged 50 years or older receiving one of six vaccination strategies or no vaccination. Age-specific incidence, mortality, costs, and quality-adjusted life years (QALYs) were included. Two-time horizons (5 and 10 years, with 5 years for individuals aged 65 years or older) were modeled. Probabilistic and deterministic sensitivity analyses were used to assess uncertainty. PCV13, PCV15, PCV20, and PCV13 + PPSV23 were cost-effective against no intervention at a 10-year horizon (ICERs: $2.112, $7.630, $2.516, and $8.003 per QALY, respectively), with PCV20 having the highest probability of being the most cost-effective strategy (73.4% at an $8,266 willingness-to-pay threshold). Also, PCV20 prevented the most significant number of pneumococcal disease cases, deaths, and complications over the model horizon (1,427 deaths averted). PPSV23 and PCV15 + PPSV23 strategies were less effective and more costly over time. PCV20 offers the most favorable economic and clinical profile among pneumococcal vaccination strategies for Colombian adults aged 50 years and older. Its use would maximize health gains, reduce healthcare costs over time, and support efficient resource allocation within the Colombian health system. Not applicable.