Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil |
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| Affiliation: | 1. Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, ICHC, 4° andar, sala 4028 Cerqueira César, 05403-000 São Paulo, SP, Brazil;2. Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 2° andar, sala 2228, CEP: 01246-903, São Paulo, SP, Brazil;1. Dirección Nacional de Control de Enfermedades Inmunoprevenibles (DiNaCEI), Ministerio de Salud de la Nación, Argentina;2. Fundacion INFANT, Buenos Aires, Argentina;3. Vanderbilt University, Nashville, TN, United States;4. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina;1. KU Leuven, University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Leuven University Vaccinology Center (LUVAC), B-3000 Leuven, Belgium;2. KU Leuven, University of Leuven, Department of Public Health and Primary Care, Centre for Environment and Health, Youth Health Care, B-3000 Leuven, Belgium;3. KU Leuven, University of Leuven, Department of Development and Regeneration, Department of Obstetrics and Gynaecology, University Hospitals Leuven, B-3000 Leuven, Belgium;1. Nursing Department, Universitat Autònoma de Barcelona, Can Domènech, Edifici M, Campus de la Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain;2. Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d’Hebron, Paseo de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain;1. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom;2. Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, England, United Kingdom;3. Statistics and Modelling Unit, Public Health England, London, England, United Kingdom;1. Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium;2. National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam;3. National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium;4. Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belguim;5. Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium;6. School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam;1. Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;2. Laboratory for Infectious Diseases and Perinatal Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands |
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| Abstract: | BackgroundPertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil.MethodsEconomic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed.ResultsMaternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness.ConclusionThe results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil. |
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| Keywords: | Cost-benefit analysis Cost-effectiveness analysis Maternal immunization Pertussis vaccine Pertussis Whooping cough Pregnancy |
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