Comparison of static and dynamic models of maternal immunization to prevent infant pertussis in Brazil |
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Authors: | Louise B. Russell Sun-Young Kim Cristiana Toscano Ben Cosgriff Ruth Minamisava Ana Lucia Andrade Colin Sanderson Anushua Sinha |
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Affiliation: | 1. University of Pennsylvania, Department of Medical Ethics and Health Policy, c/o Lauren Counterman, 423 Guardian Drive, Philadelphia, PA 19104, USA;2. Seoul National University, Department of Public Health Sciences, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea;3. Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil;4. Consultant, Westfield, NJ 07090, USA;5. School of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil;6. London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom;7. Department of Health Systems and Policy, School of Public Health, Rutgers University, Piscataway, NJ, USA |
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Abstract: | BackgroundThis paper compares cost-effectiveness results from two models of maternal immunization to prevent pertussis in infants in Brazil, one static, one dynamic, to explore when static models are adequate for public health decisions and when the extra effort required by dynamic models is worthwhile.MethodsWe defined two scenarios to explore key differences between static and dynamic models, herd immunity and time horizon. Scenario 1 evaluates the incremental cost/DALY of maternal acellular pertussis (aP) immunization as routine infant vaccination coverage ranges from low/moderate up to, and above, the threshold at which herd immunity begins to eliminate pertussis. Scenario 2 compares cost-effectiveness estimates over the models’ different time horizons. Maternal vaccine prices of $9.55/dose (base case) and $1/dose were evaluated.ResultsThe dynamic model shows that maternal immunization could be cost-saving as well as life-saving at low levels of infant vaccination coverage. When infant coverage reaches the threshold range (90–95%), it is expensive: the dynamic model estimates that maternal immunization costs $2 million/DALY at infant coverage > 95% and maternal vaccine price of $9.55/dose; at $1/dose, cost/DALY is $200,000. By contrast, the static model estimates costs/DALY only modestly higher at high than at low infant coverage. When the models’ estimates over their different time horizons are compared at infant coverage < 90–95%, their projections fall in the same range.ConclusionsStatic models may serve to explore an intervention’s cost-effectiveness against infectious disease: the direction and principal drivers of change were the same in both models. When, however, an intervention too small to have significant herd immunity effects itself, such as maternal aP immunization, takes place against a background of vaccination in the rest of the population, a dynamic model is crucial to accurate estimates of cost-effectiveness. This finding is particularly important in the context of widely varying routine infant vaccination rates globally.Clinical Trial registryClinical Trial registry name and registration number: Not applicable. |
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Keywords: | Cost-effectiveness Dynamic transmission model Infectious disease model Maternal immunization Pertussis Static model |
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