OBJECTIVES : Pneumococcal-disease in adults, including community-acquired-pneumonia (CAP) and invasive-pneumococcal-disease (IPD), is a global problem, especially in individuals with chronic-diseases such as COPD, diabetes-mellitus (DM) and chronic-heart-disease (CHD). A vaccination recommendation for these populations exists (aged ≥50) in Austria. A sequential vaccination, PNC13 and after ≥8 weeks PPV23, is strongly recommended. This sequential vaccination should be repeated every 6 years. The aim of the BIA is to compare the current situation with a higher vaccination-coverage scenario. The budget-impact quantifies the effect due to vaccination regarding health-care budget and events avoided.

METHODS : A multi-cohort, population-based model was developed over a 5-year time-horizon for each risk-group (COPD, DM, CHD; ≥50 years). The following states were included: hospitalized/outpatient CAPs, IPDs, associated complications and mortality. The current vaccination-rate is 14% (1^st year) to 22% (5^th year). After the market shift, a vaccination-rate of 60% is assumed. The model includes a serotype shift over time. Results showed savings form the health-care-systems perspective and prevented events (CAPs, IPDs and deaths).

RESULTS : In COPD patients (N=94,885; GOLD III) an increased vaccination-rate results in total savings of 41.6 million € (m€) over 5 years; between 5.8 m€ (1^st year) to 11.2 m€ (5^th year). In total 8,967 CAPs, 343 IPDs and 753 deaths could be avoided. A higher vaccination-rate in the DM population (N=340,890) leaded in total savings of 21.3 m€ over 5 years; 4.0 m€ (1^st year) to 4.6 m€ (5^th year). Savings are associated with 8,852 prevented CAPs, 174 IPDs and 531 deaths in a 5 year time horizon. In the CHD risk-group (N= 280,163) saving of 27.2 m€ could be achieved in total; 5.5 m€ (1^st year) to 5.9 m€ (5^th year). 7,974 CAPs, 189 IPDs and 704 deaths could be avoided.

CONCLUSIONS : In Austria, 1€ invested in pneumococcal vaccination obtained a return-on-investment between 2 and 13.3€ for the health-care-system.