Wilson M, Althouse BM, Lucas A, Tort MJ, Rozenbaum MH. A comparative analysis of pediatric pneumococcal vaccination strategies: a dynamic model of PCV20 vs. PCV15 and PCV13. Vaccine. 2026 Feb 25;77:128350. doi: 10.1016/j.vaccine.2026.128350

BACKGROUND: Both 20-valent (PCV20) and 15-valent (PCV15) pneumococcal conjugate vaccines are recommended in the US pediatric immunization program. Static models previously have found PCV20 cost-effective compared to PCV15 and a 13-valent vaccine (PCV13). The objective of this study is to assess the health and economic impact of PCV20 compared to PCV15 or PCV13 using a dynamic transmission model (DTM).

METHODS: An age-structured, compartmental DTM was developed to simulate the transmission dynamics of Streptococcus pneumoniae in the US, calibrated to historical invasive pneumococcal disease (IPD) incidence. The model estimated the impact of PCV20 versus PCV15 and PCV13 in the routine pediatric vaccination program in the US. Pneumococcal pneumonia (PP) and otitis media (OM) incidence were assumed a proportional relationship to IPD. Outcomes included disease cases, quality-adjusted life-years (QALYs), direct medical costs (2025 USD), and incremental cost-effectiveness ratio for the entire US population (328,239,522) over a 10-year horizon.

RESULTS: Compared with PCV15, PCV20 pediatric vaccination averted 4.0 million disease cases (31,361 IPD, 0.889 million PP, and 3.1 million pneumococcal OM) with cost savings of $4.027 billion over 10 years. PCV20 resulted in an additional 17,717 QALY versus PCV15, thus PCV20 was dominant (cost saving and more effective) compared with PCV15. PCV20 was also dominant versus PCV13, with incremental cost savings of $5.940 billion and 26,099 additional QALY over 10 years.

CONCLUSIONS: Pediatric PCV20 use is projected to reduce pneumococcal disease burden and healthcare costs in the US compared with PCV15 or PCV13. Results support the health and economic value of adopting a higher-valent pediatric vaccination approach using PCV20.