A Comparative Economic Analysis of Immunization Programs for Pertussis and Measles: The Use of ARIMA Model to Study the Epidemiological Situation in England and Wales

Abstract

Objective: We evaluate pertussis and measles immunization strategies and compare the consequences in terms of health effects and economic costs. Methods: Based on epidemiological data for pertussis and measles in England and Wales from 1970 to 2012, we use ARIMA approach to model the relation between notification cases and vaccination coverage for each disease. We then perform an economic evaluation of vaccination programs at 95% and discuss the benefits for the society to achieve this level when compared with lower vaccination rates currently observed. The advantages for the society of increasing vaccination coverage up to 98% are considered respectively for pertussis and measles. Results: The programs at a 95% vaccination rate, which is able to significantly reduce the mortality and the morbidity due to pertussis and measles, are confirmed to be the best cost saving immunization strategy. The total social net benefits are systematically maximized when the programs are compared to strategies with lower vaccination coverage. The decision to exceed the herd immunity level and reach the rate at 98% is economically justified for measles, while for pertussis the programs at 98% are less cost effective than the programs at 95%. Conclusion: Additional efforts must be carried out to promote measles vaccination since immunization strategies at 95% and at higher rates are recommended on epidemiological and economic grounds.