Abstract
ObjectivesIn February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ≥65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ≥65 to “baseline” practice [full-strength DTaP administered from 2 months to 4–6 years, and one dose of Tdap at 11–64 years replacing decennial Td booster], using a dynamic model.MethodsWe constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ≥65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges.ResultsFor the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are $47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios.ConclusionsImmunization of eligible adults aged ≥65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives.
Highlights
The full-strength diphtheria-tetanus-acellular pertussis vaccine, DTaP, was first approved in the US in 1991 for the 4th and 5th doses in the 5-dose diphtheria, tetanus and pertussis series
As of 2005, Advisory Committee on Immunization Practices (ACIP) recommends that adolescents 11–18 years and adults 19 through 64 years receive a single dose of reduced-antigen content combined tetanus, diphtheria, and pertussis (Tdap) vaccine, which protects against pertussis, as a one-time replacement for a tetanus-diphtheria vaccine (Td) decennial booster [2]
We replicated assumptions from a previously-published economic analysis [14], assuming the same structure and transmission parameter estimates, to explore the impact of including asymptomatic infections in the disease model. Under both the baseline and intervention strategies, the model predicts that the one-year pertussis incidence will be greatest among infants, followed by adults aged 20–64 years, adults aged $65 years, children, and adolescents
Summary
The full-strength diphtheria-tetanus-acellular pertussis vaccine, DTaP, was first approved in the US in 1991 for the 4th and 5th doses in the 5-dose diphtheria, tetanus and pertussis series. The tetanus-diphtheria vaccine (Td) is given to adolescents and adults as a booster every 10 years, or after an exposure to tetanus. As of 2005, ACIP recommends that adolescents 11–18 years (preferably at age 11 or 12) and adults 19 through 64 years receive a single dose of reduced-antigen content combined tetanus, diphtheria, and pertussis (Tdap) vaccine, which protects against pertussis, as a one-time replacement for a Td decennial booster [2]. In 2010, ACIP recommended the expanded use of Tdap, advising that children aged 7 through 10 years not previously fully vaccinated against pertussis receive a single dose of Tdap, and that adults $65 years who have close contact with an infant receive a single dose of
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