Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis |
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| Affiliation: | 1. National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China;2. School of Public Administration and Policy, Renmin University of China, Beijing, China;3. Health Science, Hospital Reform and Medical Big Data Liberal Arts and Sciences Cross Platform, Renmin University of China, Beijing, China;4. China Center for Health Development Studies, Peking University, Beijing, China;5. Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China;6. Institute of Global Health and Development, Peking University, Beijing, China;1. School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China;2. The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China;3. School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China;1. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China;2. Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA;3. School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China;4. Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China;5. Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China;6. Center for Health Information Research, Sun Yat-sen University, Guangzhou, China;1. Department of Economics, UNC Greensboro, Greensboro, NC, USA;2. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;3. RTI International, Chicago, IL, USA;4. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA;1. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA;2. Center for Global Public Health, Tufts University School of Medicine, Boston, MA, USA;3. Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA;4. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA;5. Department of Medicine, Harvard Medical School, Boston, MA, USA;6. TB Centre, London School of Hygiene & Tropical Medicine, London, England, UK;1. Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia;2. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University;3. Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia;4. QIMR Berghofer Medical Research Institute, Herston, QLD, Australia;5. Metro North Mental Health Service, Herston, QLD, Australia;6. Child and Adolescent Mental Health Services Barwon Health, Geelong, VIC, Australia;7. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia;8. Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia;9. Royal Children’s Hospital, Melbourne, VIC, Australia;10. Murdoch Children’s Research Institute, Melbourne, VIC, Australia;11. Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia;12. School of Population Health, Curtin University, Perth, WA, Australia;13. Caring Futures Institute, Flinders University, Adelaide, SA, Australia;14. Children’s Health, Queensland Hospital and Health Service, University of Queensland, Herston, QLD, Australia;15. Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology, Sydney, NSW, Australia |
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| Abstract: | ObjectivesThis study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017.MethodsWe conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges.ResultsWithout DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust.ConclusionsOver the lifetime of 40 birth cohorts, China’s immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society. |
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| Keywords: | benefit-cost analysis China diphtheria-tetanus-acellular pertussis vaccine diphtheria tetanus whole-cell pertussis vaccine economic evaluation pertussis vaccination |
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