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Background In June 2019, the U.S. Advisory Committee on Immunization Practices changed the recommendation for routine PCV13 use in immunocompetent adults aged ≥65, including those with certain chronic medical conditions (CMC); PCV13 is now recommended based on shared clinical decision-making. Adults with CMC continue to be at increased risk for pneumococcal disease. We assessed the cost-effectiveness of adding PCV13 to the recommended PPSV23 dose for adults aged ≥19 years with CMC. Methods We used a probabilistic model following a cohort of 19-year-old U.S. adults. We used Monte Carlo simulation to estimate the impact on program, medical, and non-medical costs (in 2017 U.S. dollars [$] using the societal perspective), and pneumococcal disease burden when administering PCV13 in series with PPSV23. Table 1 shows vaccine effectiveness (VE) assumptions for the base case. We performed one-way sensitivity analyses assuming higher PCV13 VE against serotype 3 disease. Vaccine effectiveness assumptions by age group used for the base case Results In the base-case scenario, adding a dose of PCV13 upon CMC diagnosis cost $689,299 per QALY. Results of one-way sensitivity analyses are presented in Table 2. Base case and one-way sensitivity analyses of adding PCV13 at diagnosis of CMC Conclusion Adding PCV13 in series with PPSV23 for adults 19 years or older with CMC was not cost-saving. Results were sensitive to assumptions on PCV13 VE against serotype 3 disease. Disclosures All Authors: No reported disclosures

20. Cost-Effectiveness of Implementing 13-Valent Pneumococcal Conjugate Vaccine (Pcv13) for Adults Aged ≥19 Years with Underlying Conditions