# Evaluating Free PPV23 Vaccination for the Elderly in Nanning, China: A Cost-Effectiveness Analysis

## TL;DR

This study compares the cost-effectiveness of free versus self-paid pneumococcal vaccination for elderly people in Nanning, China.

## Contribution

The study introduces a novel cost-effectiveness analysis of free PPV23 vaccination for the elderly in a specific Chinese setting.

## Key findings

- Free vaccination had a higher net benefit (USD 399,651.32) compared to self-funded vaccination.
- Both vaccination strategies had benefit–cost ratios below the cost-effectiveness threshold of 1.
- Free vaccination showed greater economic efficiency with a lower ICER.

## Abstract

Background: This study aims to evaluate the cost-effectiveness of providing the 23-valent pneumococcal polysaccharide vaccine (PPV23) free of charge versus self-paying vaccination among adults aged 60 years and older in Nanning, Guangxi, China. Methods: A decision tree–Markov model was developed to compare three strategies (government-funded free vaccination, self-funded vaccination, and no vaccination) over a 5-year time horizon. The model incorporated local epidemiological data and cost parameters, applying a 3% discount rate. Sensitivity analyses were conducted on key parameters, including vaccine effectiveness against pneumonia and pneumonia treatment costs. Results: The benefit–cost ratios for free and self-funded vaccination were 0.075 and 0.015, respectively, both below the cost-effectiveness threshold of 1. However, the free vaccination strategy resulted in a higher net benefit (USD 399,651.32) compared to the self-funded strategy (USD 222,594.14), along with a lower Incremental Cost-Effectiveness Ratio (ICER) (USD 1.47 per USD 0.14 of avoided disease cost). Although both strategies yielded benefit–cost ratios far below the conventional threshold of 1, the free strategy demonstrated relatively greater economic efficiency. Sensitivity analyses confirmed that vaccine effectiveness against pneumonia and treatment costs were key drivers of economic outcomes. Conclusions: While neither vaccination strategy achieved conventional cost-effectiveness benchmarks in this setting, the free PPV23 vaccination program demonstrated relatively greater economic efficiency compared to the self-funded approach; although neither strategy met the conventional cost-effectiveness thresholds, they should be considered for inclusion in regional health policy for older adults.