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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

Probabilistic sensitivity analysis, societal perspective.
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pone-0067260-g004: Probabilistic sensitivity analysis, societal perspective.

Mentions: The PSA using 1,000 simulations resulted in a distribution of incremental costs and QALYs gained with a mean ICER of $39,500 and 95% of ICER values falling between $28,900 and $53,400 (Figure 4). In all simulations, both incremental costs and QALYs were higher for the Tdap versus Td vaccination program.


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)

Probabilistic sensitivity analysis, societal perspective.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0067260-g004: Probabilistic sensitivity analysis, societal perspective.
Mentions: The PSA using 1,000 simulations resulted in a distribution of incremental costs and QALYs gained with a mean ICER of $39,500 and 95% of ICER values falling between $28,900 and $53,400 (Figure 4). In all simulations, both incremental costs and QALYs were higher for the Tdap versus Td vaccination program.

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