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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.

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Related in: MedlinePlus

Tdap waning vaccine efficacy.
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pone-0067260-g003: Tdap waning vaccine efficacy.

Mentions: We assumed that 10% of the population aged 65 years old will receive Tdap in the intervention group and Td in the comparison group; this is consistent with an equal portion of the population becoming eligible for the decennial Td booster each year. Tdap vaccine efficacy in the base case was estimated to be 89%. Tdap efficacy was not directly measured but estimated via immunobridging to an infant DTaP efficacy study (Infanrix®, GlaxoSmithKline) [15]. In the study used for efficacy bridging, vaccine efficacy was shown to be 89%. A scenario analysis was conducted assuming 77% efficacy based on the lower limit of the 95% confidence interval in the DTaP vaccine efficacy trial [13]. Waning immunity is assumed to occur at a constant rate, with a mean duration of protection of 8 years (Figure 3) [16]. Scenario analyses were conducted with alternative duration of protection estimates of 6 and 10 years.


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)

Tdap waning vaccine efficacy.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0067260-g003: Tdap waning vaccine efficacy.
Mentions: We assumed that 10% of the population aged 65 years old will receive Tdap in the intervention group and Td in the comparison group; this is consistent with an equal portion of the population becoming eligible for the decennial Td booster each year. Tdap vaccine efficacy in the base case was estimated to be 89%. Tdap efficacy was not directly measured but estimated via immunobridging to an infant DTaP efficacy study (Infanrix®, GlaxoSmithKline) [15]. In the study used for efficacy bridging, vaccine efficacy was shown to be 89%. A scenario analysis was conducted assuming 77% efficacy based on the lower limit of the 95% confidence interval in the DTaP vaccine efficacy trial [13]. Waning immunity is assumed to occur at a constant rate, with a mean duration of protection of 8 years (Figure 3) [16]. Scenario analyses were conducted with alternative duration of protection estimates of 6 and 10 years.

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