IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0067260.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067260
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0067260&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0067260?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc.
    2. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
    3. Janel Hanmer & William F. Lawrence & John P. Anderson & Robert M. Kaplan & Dennis G. Fryback, 2006. "Report of Nationally Representative Values for the Noninstitutionalized US Adult Population for 7 Health-Related Quality-of-Life Scores," Medical Decision Making, , vol. 26(4), pages 391-400, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Carmen Herrero Blanco & Juan D. Moreno Ternero, 2002. "Economic Evaluation Of Newborn Hearing Screening Procedures," Working Papers. Serie AD 2002-06, Instituto Valenciano de Investigaciones Económicas, S.A. (Ivie).
    2. Paal Joranger & Arild Nesbakken & Halfdan Sorbye & Geir Hoff & Arne Oshaug & Eline Aas, 2020. "Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 321-334, April.
    3. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost–utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433, April.
    4. Bengt Liljas, 2011. "Welfare, QALYs, and costs – a comment," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 68-72, January.
    5. Douglas Lundin & Joakim Ramsberg, 2008. "On survival consumption costs – a reply to Nyman," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 293-297, February.
    6. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    7. Gary Becker & Kevin Murphy & Tomas Philipson, 2007. "The Value of Life Near its End and Terminal Care," Levine's Working Paper Archive 122247000000001428, David K. Levine.
    8. John A. Nyman, 2006. "More on survival consumption costs in cost‐utility analysis," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 319-322, March.
    9. Kenneth Manton & Kenneth Land, 2000. "Active life expectancy estimates for the U.S. elderly population: A multidimensional continuous-mixture model of functional change applied to completed Cohorts, 1982–1996," Demography, Springer;Population Association of America (PAA), vol. 37(3), pages 253-265, August.
    10. Joel Thompson & Amir Abdolahi & Katia Noyes, 2013. "Modelling the Cost Effectiveness of Disease-Modifying Treatments for Multiple Sclerosis," PharmacoEconomics, Springer, vol. 31(6), pages 455-469, June.
    11. Stefan Felder, 2006. "Lebenserwartung, medizinischer Fortschritt und Gesundheitsausgaben: Theorie und Empirie," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 7(s1), pages 49-73, May.
    12. Anirban Basu & Bhakti V. Arondekar & Paul J. Rathouz, 2006. "Scale of interest versus scale of estimation: comparing alternative estimators for the incremental costs of a comorbidity," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1091-1107, October.
    13. Philipson Tomas J & Jena Anupam B, 2006. "Who Benefits from New Medical Technologies? Estimates of Consumer and Producer Surpluses for HIV/AIDS Drugs," Forum for Health Economics & Policy, De Gruyter, vol. 9(2), pages 1-33, January.
    14. Ernst R. Berndt & David M. Cutler & Richard Frank & Zvi Griliches & Joseph P. Newhouse & Jack E. Triplett, 2001. "Price Indexes for Medical Care Goods and Services -- An Overview of Measurement Issues," NBER Chapters, in: Medical Care Output and Productivity, pages 141-200, National Bureau of Economic Research, Inc.
    15. Aaron A. Stinnett & A. David Paltiel, 1997. "Estimating CE Ratios under Second-order Uncertainty," Medical Decision Making, , vol. 17(4), pages 483-489, October.
    16. Pieter H. M. van Baal & Talitha L. Feenstra & Johan J. Polder & Rudolf T. Hoogenveen & Werner B. F. Brouwer, 2011. "Economic evaluation and the postponement of health care costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 432-445, April.
    17. Klas Kellerborg & Werner Brouwer & Pieter Baal, 2020. "Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1329-1350, December.
    18. Kenkel, Don, 1997. "On valuing morbidity, cost-effectiveness analysis, and being rude," Journal of Health Economics, Elsevier, vol. 16(6), pages 749-757, December.
    19. Liqun Liu & Andrew J. Rettenmaier & Thomas R. Saving, 2008. "Longevity bias in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 523-534, April.
    20. Michael E. Darden & Robert Kaestner, 2022. "Smoking, selection, and medical care expenditures," Journal of Risk and Uncertainty, Springer, vol. 64(3), pages 251-285, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0067260. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.