Health utilities associated with pneumococcal diseases in children and adults: a targeted literature review and meta-analysis

Background: Pneumococcal disease and post-meningitis sequelae (PMS) impact health-related quality of life (HRQoL). However, health utility estimates for these conditions vary considerably in the literature, which may affect the outcomes of economic evaluations.

Objectives: The aim was to generate pooled estimates of quality-adjusted life year (QALY) decrements per episode for pneumococcal disease and pooled health state utility value (HSUV) estimates for PMS in children and adults.

Methods: Global targeted literature reviews were conducted in MEDLINE in June 2024 to identify original studies on the health utilities of pneumococcal disease and PMS. Random-effects meta-analyses were conducted separately for children (< 18 years) and adults (≥ 18 years) to calculate pooled estimates of QALY decrements per episode for pneumococcal disease states and pooled HSUV estimates for PMS.

Results: A total of 40 studies, published from 1993–2022, were included. Fifteen were conducted among children, 19 among adults, and six among both age groups. In children, the pooled QALY decrement estimates (95% confidence interval [CI]) per episode were 0.023 (0.017–0.030) for meningitis, 0.010 (0.003–0.017) for bacteremia/sepsis, 0.014 (0.002–0.026) for inpatient pneumonia, 0.010 (0.002–0.017) for outpatient pneumonia, 0.008 (0.003–0.013) for unspecified pneumonia, 0.005 (0.005–0.006) for recurrent/complex acute otitis media (AOM), and 0.003 (0.001–0.005) for simple AOM. The pooled HSUV estimates for PMS in children were 0.485 (0.322–0.649) for neurological deficits, 0.701 (0.563–0.839) for hearing loss, and 0.827 (0.713–0.941) for unspecified PMS. In adults, the pooled QALY decrement estimates per episode (95% CI) were 0.027 (0.018–0.036) for meningitis, 0.013 (0.000–0.027) for bacteremia/sepsis, 0.015 (0.008–0.021) for inpatient pneumonia, 0.007 (0.005–0.008) for outpatient pneumonia, and 0.009 (0.001–0.018) for unspecified pneumonia. The pooled HSUV estimates for PMS in adults were 0.556 (0.447–0.665) for neurological deficits, 0.700 (0.631–0.768) for hearing loss, and 0.778 (0.744–0.812) for unspecified PMS. Moderate to high heterogeneity levels were observed in most of the meta-analyses performed in this study.

Conclusions: Pneumococcal disease and PMS substantially reduce HRQoL in children and adults, with the greatest impacts observed with meningitis, inpatient pneumonia, and bacteremia/sepsis. There is considerable variability in utility estimates across studies, likely driven by methodological differences. This analysis provides a comprehensive quantitative synthesis of QALY decrement estimates for pneumococcal disease states and HSUV estimates for PMS, improving our understanding of the HRQoL burden and potentially enhancing the comparability of future economic evaluations of pneumococcal vaccines.