Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil

Monday, 14th of March 2016

Vaccine. 2016 Mar 18;34(13):1531-9. doi: 10.1016/j.vaccine.2016.02.026. Epub 2016 Feb 17.

Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil

Sartori AM¹, de Soárez PC², Fernandes EG³, Gryninger LC⁴, Viscondi JY⁵, Novaes HM⁶.

Author information

¹Departamento 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. Electronic address: ana.sartori@hc.fm.usp.br.
²Departamento 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. Electronic address: patricia.soarez@usp.br.
³Departamento 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. Electronic address: edergatti@hotmail.com.
⁴Departamento 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. Electronic address: castellon.ligia@gmail.com.
⁵Departamento 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. Electronic address: juliana.viscondi@hc.fm.usp.br.
⁶Departamento 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. Electronic address: hidutilh@usp.br.

Abstract below; full text is available to journal subscribers

BACKGROUND:

Pertussis 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.

METHODS:

Economic 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.

RESULTS:

Maternal 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.

CONCLUSION:

The 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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