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What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis

Friday, 6th of January 2017

 

Clinical Infectious Diseases, Volume 63, Issue suppl 4, pp. S227-S235.

What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis

1. Louise B. Russell1,
2. Sri Ram Pentakota2,
3. Cristiana Maria Toscano3,
4. Ben Cosgriff4, and
5. Anushua Sinha5

+ Author Affiliations

1.      ¹Department of Economics and Institute for Health, New Brunswick

2.      ²Department of Surgery, New Jersey Medical School, Rutgers University, Newark

3.      ³Department of Community Health, Federal University of Goiás, Brazil

4.      ⁴Consultant, Westfield

5.      ⁵Department of Health Systems and Policy, School of Public Health, Rutgers University, Piscataway, New Jersey

1. Correspondence: L. B. Russell, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ 08901 (lrussell@ifh.rutgers.edu).

Abstract below; full text is at http://cid.oxfordjournals.org/content/63/suppl_4/S227.full

Background. Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis continues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of public health resources in LMICs.

Methods. We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices, one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life-year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates.

Results. Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report. For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018 per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY.

Conclusions. For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many LMICs only if the vaccine were offered at less than $1–$2/dose.

• © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.