Cost-effectiveness of Pneumococcal Vaccination Among Patients with CKD in the United states

Ishigami, J., Padula, W. V., Grams, M. E., Chang, A. R., Jaar, B., Gansevoort, R. T., Bridges, J. F. P., Kovesdy, C. P., Uchida, S., Coresh, J. & Matsushita, K., Jul-2019, In : American Journal of Kidney Diseases. 74, 1, p. 23-35 13 p.

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  • Cost-effectiveness of Pneumococcal Vaccination Among Patients With CKD in the United States

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  • Junichi Ishigami
  • William V Padula
  • Morgan E Grams
  • Alexander R Chang
  • Bernard Jaar
  • Ron T Gansevoort
  • John F P Bridges
  • Csaba P Kovesdy
  • Shinichi Uchida
  • Josef Coresh
  • Kunihiro Matsushita

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.

Original languageEnglish
Pages (from-to)23-35
Number of pages13
JournalAmerican Journal of Kidney Diseases
Issue number1
Early online date2019
Publication statusPublished - Jul-2019



ID: 78348813