Limits...
Cost-effectiveness analysis of Tdap in the prevention of pertussis in the elderly.

McGarry LJ, Krishnarajah G, Hill G, Skornicki M, Pruttivarasin N, Masseria C, Arondekar B, Pelton SI, Weinstein MC - PLoS ONE (2013)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: OptumInsight, Cambridge, Massachusetts, United States of America.

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.

Show MeSH

Related in: MedlinePlus

Economic model.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3760878&req=5

pone-0067260-g002: Economic model.

Mentions: The economic model (Figure 1–2) was constructed in Microsoft Excel®. The model assesses the cost-effectiveness of vaccinating a cohort of adults aged 65 years with Tdap, by calculating pertussis cases averted due to direct vaccine effects only. Results were evaluated from the societal and the payer perspectives. The societal perspective, which is consistent with the Reference Case recommendations of the US Panel on Cost-Effectiveness in Health and Medicine [9], considers both direct medical costs of pertussis treatment and direct non-medical costs of patient 's time in hospital. The payer perspective considers only direct medical-care costs.


Cost-effectiveness analysis of Tdap in the prevention of pertussis in the elderly.

McGarry LJ, Krishnarajah G, Hill G, Skornicki M, Pruttivarasin N, Masseria C, Arondekar B, Pelton SI, Weinstein MC - PLoS ONE (2013)

Economic model.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3760878&req=5

pone-0067260-g002: Economic model.
Mentions: The economic model (Figure 1–2) was constructed in Microsoft Excel®. The model assesses the cost-effectiveness of vaccinating a cohort of adults aged 65 years with Tdap, by calculating pertussis cases averted due to direct vaccine effects only. Results were evaluated from the societal and the payer perspectives. The societal perspective, which is consistent with the Reference Case recommendations of the US Panel on Cost-Effectiveness in Health and Medicine [9], considers both direct medical costs of pertussis treatment and direct non-medical costs of patient 's time in hospital. The payer perspective considers only direct medical-care costs.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: OptumInsight, Cambridge, Massachusetts, United States of America.

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.

Show MeSH
Related in: MedlinePlus