The health and economic burden of pertussis in Canada: A microsimulation study |
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| Affiliation: | 1. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;2. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada;1. Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA;2. Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48103, USA;3. Division of Immunizations, Michigan Department of Health and Human Services, 333 S. Grand Ave., Lansing, MI 48909, USA;4. Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA;1. Biomedicine Unit, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Avenida de los Barrios 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico;2. Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico;1. Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada;2. Public Health Ontario, Toronto, ON, Canada;3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;4. Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada;5. ICES, Toronto, ON, Canada;6. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;7. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada |
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| Abstract: | BackgroundDespite excellent vaccine coverage, pertussis persists in Canada, with high incidence during recent outbreaks and non-negligible incidence in non-outbreak years. While Canadian pertussis incidence is well-characterized, the full health and economic impact of pertussis have not been examined in Canada. We estimated age-specific life years (LYs) and quality-adjusted life years (QALYs) lost, and costs due to pertussis in Ontario, Canada, using a model-based approach.MethodsWe developed a microsimulation model to simulate pertussis natural history. Daily probabilities of pertussis complications, hospitalizations, and disease sequelae as well as utilities and costs for health states were literature-derived. A healthcare payer perspective was used with a lifetime time horizon. Model outcomes were compared to those from a model with no pertussis health states. Probabilistic sensitivity analyses were used to generate distributions for estimates. Economic burden was estimated by multiplying case cost estimates by annual age-specific incidence.ResultsOverall, LYs lost per pertussis case was low, with negligible LYs lost in those aged >4 years. Infants (<6 months) had the greatest mean QALY loss per case (0.58), while adults lost only 0.05 QALYs per case. Infants experienced the greatest mean cost per case of $22,768 (95% CI: 21,144–23,406). Case costs generally declined with age, but increased in seniors (aged 65+) with mean cost of $1920 (95% CI: 1800–2033). Based on historic age-specific incidence, pertussis costs the Ontario healthcare system approximately $7.6–$21.5 M annually. In total economic cost estimates with QALYs valued at 1xGDP (3xGDP) per capita, the net impact of pertussis in Ontario was estimated at $21.7–$66.5 M annually ($50.0–$156.3 M). For all of Canada, total economic costs were estimated at $79.6–$241.3 M ($187.5–$580.5 M) annually.ConclusionThe health and economic consequences of pertussis persistence are substantial and highlight the need for improved control strategies. |
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| Keywords: | Pertussis Whooping cough Burden of disease Health economics Epidemiology |
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