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Title: Cost-Effectiveness of Tdap Vaccination of Adults Aged ≥65 Years in the Prevention of Pertussis in the US: A Dynamic Model of Disease Transmission
Authors: McGarry, Lisa J.;Krishnarajah, Girishanthy;Hill, Gregory;Masseria, Cristina;Skornicki, Michelle;Pruttivarasin, Narin;Arondekar, Bhakti;Roiz, Julie;Pelton, Stephen I.;Weinstein, Milton C.
subject: Medicine;Clinical Immunology;Immunity;Vaccination;Vaccines;Non-Clinical Medicine;Health Care Policy;Health Economics;Health Services Research;Public Health;Socioeconomic Aspects of Health;Social and Behavioral Sciences;Economics;Human Capital;Economics of Health
Year: 2014
Publisher: Public Library of Science
Description: Objectives: In February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ≥65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ≥65 to “baseline” practice [full-strength DTaP administered from 2 months to 4–6 years, and one dose of Tdap at 11–64 years replacing decennial Td booster], using a dynamic model. Methods: We constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ≥65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges. Results: For the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are $47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios. Conclusions: Immunization of eligible adults aged ≥65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives.
Standard no: McGarry, Lisa J., Girishanthy Krishnarajah, Gregory Hill, Cristina Masseria, Michelle Skornicki, Narin Pruttivarasin, Bhakti Arondekar, Julie Roiz, Stephen I. Pelton, and Milton C. Weinstein. 2014. “Cost-Effectiveness of Tdap Vaccination of Adults Aged ≥65 Years in the Prevention of Pertussis in the US: A Dynamic Model of Disease Transmission.” PLoS ONE 9 (1): e72723. doi:10.1371/journal.pone.0072723.
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