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Diseases caused by Streptococcus pneumonia contribute considerably to morbidity and mortality worldwide [1]. The main types of illness are grouped as bacteremic pneumococcal pneumonia (BPP) and non-bacteremic pneumococcal pneumonia (NBPP), the latter causing less serious manifestations [1, 2]. Pneumococcal vaccination for infants has been widely debated in the last decade following the launch of the new and expensive conjugate vaccines (PCVs); unlike the old and cheap 23-valent polysaccharide vaccine (PPV23), PCV vaccines are immunogenic in children under 2 years of age [3]. Lately, the debate has shifted to the extension of PCV13 (the only PCV approved for adults) to at-risk and older adults instead of PPV23, which is still adopted in many European countries for campaigning on this population target. This hot debate [4, 5] is fuelled by two crucial issues that are still uncertain. First, although PPV23 has been shown to be effective in older adults, the extent and especially the duration of its protection are still doubtful [6, 7]. Second, vaccination of infants with PCVs (unlike with PPV23) provides herd immunity that has an impact on serotype replacement [8] and thus prevents disease in all ages [9], elderly included. Against this background, economic evaluations (EEs) of pneumococcal vaccines for adults published so far have had to rely on many assumptions [4, 10]. Very recently, the CAPiTA (Community-Acquired Pneumonia Immunization Trial in Adults) study (a Dutch clinical trial supported by the manufacturer) [11] showed that PCV13 is efficacious in preventing two thirds of BPP (75 %) and around half the NBPP (45 %) cases in older adults. The Spanish CAPAMIS (Community-Acquired Pneumonia, Acute Myocardial Infarction and Stroke) cohort study [12] (funded by public authorities) confirmed that PPV23 is effective against both BPP (62 %) and NBPP (48 %) in adults C60 years [5], although only for up to 5 years after vaccination. Here we critically review the most recent EEs published in the EU focussed on the elderly, to assess their potential contribution to public decision making and examine whether sponsorship by manufacturers influenced the results, as happened for studies focussed on infants [13].

Economic Evidence of Pneumococcal Vaccination in Older Adults: Uncertain Modelling or Competitive Tendering?