Economic impact of implementing decennial tetanus toxoid,reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination in adults in the United States |
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| Affiliation: | 1. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;2. Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;3. Department of Epidemiology, College of Public Health, University of Georgia, Athens, GA, United States;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;1. Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and the Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;2. School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada;3. Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada;4. School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada;5. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada;6. Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada;7. Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia, Canada;1. Division of Preparedness and Emerging Infections, Emergency Preparedness and Response Branch, Centers for Disease Control and Prevention, 1600 Clifton Road MS H24-11, Atlanta, GA 30329, United States;2. Division of Vector-Borne Diseases, Arboviral Diseases Branch, Centers for Disease Control and Prevention, 3156 Rampart Rd, Fort Collins, CO 80521, United States;1. Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States;2. Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States;3. Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States;1. Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA;2. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA;3. Immunization Safety Office, Centers for Disease Control and Prevention (CDC), USA;4. Department of Pediatrics, Vanderbilt University, Nashville, TN, USA;5. Department of Biostatistics, Vanderbilt University, Nashville, TN, USA;6. Division of Bacterial Diseases, Centers for Disease Control and Prevention (CDC), USA;7. Department of Pediatrics, Duke University, Durham, NC, USA |
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| Abstract: | BackgroundIn the United States, persons ≥11 years are recommended to receive one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, followed by decennial tetanus- and diphtheria-toxoid (Td) boosters. Many providers use Tdap instead of Td. We evaluated epidemiologic and economic impacts of replacing Td boosters with Tdap.MethodsWe used a static cohort model to examine replacing Td with Tdap over the lifetime of 4,386,854 adults ≥21 years. Because pertussis is underdiagnosed and true incidence is unknown, we varied incidence from 2.5 cases/100,000 person-years to 500 cases/100,000 person-years. We calculated vaccine and medical costs from claims data. We estimated cost per case prevented and per quality-adjusted life year (QALY) saved; sensitivity analyses were conducted on vaccine effectiveness (VE), protection duration, vaccine cost, disease duration, hospitalization rates, productivity loss and missed work. We did not include programmatic advantages resulting from use of a single tetanus-toxoid containing vaccine.ResultsAt lowest incidence estimates, administering Tdap resulted in high costs per averted case ($111,540) and QALY saved ($8,972,848). As incidence increased, cases averted increased and cost per QALY saved decreased rapidly. With incidence estimates of 250 cases/100,000 person-years, cost per averted case and QALY saved were $984 and $81,678 respectively; at 500 cases/100,000 person-years, these values were $427 and $35,474. In multivariate sensitivity analyses, assuming 250 cases/100,000 person-years, estimated cost per QALY saved ranged from $971 (most favorable) to $217,370 (least favorable).ConclusionsOur findings suggest that replacing Td with Tdap for the decennial booster would result in high cost per QALY saved based on reported cases. However, programmatic considerations were not accounted for, and if pertussis incidence, which is incompletely measured, is assumed to be higher than reported through national surveillance, substituting Tdap for Td may lead to moderate decreases in pertussis cases and cost per QALY. |
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| Keywords: | Pertussis Whooping cough Tdap Adult Vaccination Cost-effectiveness |
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