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Cost-Effectiveness Analysis of Tdap in the Prevention of Pertussis in the Elderly

Author

Listed:
  • Lisa J McGarry
  • Girishanthy Krishnarajah
  • Gregory Hill
  • Michelle Skornicki
  • Narin Pruttivarasin
  • Cristina Masseria
  • Bhakti Arondekar
  • Stephen I Pelton
  • Milton C Weinstein

Abstract

Objectives: Health benefits and costs of combined reduced-antigen-content tetanus, diphtheria, and pertussis (Tdap) immunization among adults ≥65 years have not been evaluated. In February 2012, the Advisory Committee on Immunization Practices (ACIP) recommended expanding Tdap vaccination (one single dose) to include adults ≥65 years not previously vaccinated with Tdap. Our study estimated the health and economic outcomes of one-time replacement of the decennial tetanus and diphtheria (Td) booster with Tdap in the 10% of individuals aged 65 years assumed eligible each year compared with a baseline scenario of continued Td vaccination. Methods: We constructed a model evaluating the cost-effectiveness of vaccinating a cohort of adults aged 65 with Tdap, by calculating pertussis cases averted due to direct vaccine effects only. Results are presented from societal and payer perspectives for a range of pertussis incidences (25–200 cases per 100,000), due to the uncertainty in estimating true annual incidence. Cases averted were accrued throughout the patient 's lifetime, and a probability tree used to estimate the clinical outcomes and costs (US$ 2010) for each case. Quality-adjusted life-years (QALYs) lost to acute disease were calculated by multiplying cases of mild/moderate/severe pertussis by the associated health-state disutility; QALY losses due to death and long-term sequelae were also considered. Incremental costs and QALYs were summed over the cohort to derive incremental cost-effectiveness ratios. Scenario analyses evaluated the effect of alternative plausible parameter estimates on results. Results: At incidence levels of 25, 100, 200 cases/100,000, vaccinating adults aged 65 years costs an additional $336,000, $63,000 and $17,000/QALY gained, respectively. Vaccination has a cost-effectiveness ratio less than $50,000/QALY if pertussis incidence is >116 cases/100,000 from societal and payer perspectives. Results were robust to scenario analyses. Conclusions: Tdap immunization of adults aged 65 years according to current ACIP recommendations is a cost-effective health-care intervention at plausible incidence assumptions.

Suggested Citation

  • Lisa J McGarry & Girishanthy Krishnarajah & Gregory Hill & Michelle Skornicki & Narin Pruttivarasin & Cristina Masseria & Bhakti Arondekar & Stephen I Pelton & Milton C Weinstein, 2013. "Cost-Effectiveness Analysis of Tdap in the Prevention of Pertussis in the Elderly," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-9, September.
    • Handle: RePEc:plo:pone00:0067260
    DOI: 10.1371/journal.pone.0067260
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    References listed on IDEAS

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