Abstract
ObjectiveThis study evaluates the cost-effectiveness of maternal acellular pertussis (aP) immunization in low- and middle-income countries using a dynamic transmission model. MethodsWe developed a dynamic transmission model to simulate the impact of infant vaccination with whole-cell pertussis (wP) vaccine with and without maternal aP immunization. The model was calibrated to Brazilian surveillance data and then used to project health outcomes and costs under alternative strategies in Brazil, and, after adjusting model parameter values to reflect their conditions, in Nigeria and Bangladesh. The primary measure of cost-effectiveness is incremental cost (2014 USD) per disability-adjusted life-year (DALY). ResultsThe dynamic model shows that maternal aP immunization would be cost-effective in Brazil, a middle-income country, under the base-case assumptions, but would be very expensive at infant vaccination coverage in and above the threshold range necessary to eliminate the disease (90–95%). At 2007 infant coverage (DTP1 90%, DTP3 61% at 1 year of age), maternal immunization would cost < $4,000 per DALY averted. At high infant coverage, such as Brazil in 1996 (DTP1 94%, DTP3 74% at 1 year), cost/DALY increases to $1.27 million. When the model’s time horizon was extended from 2030 to 2100, cost/DALY increased under both infant coverage levels, but more steeply with high coverage. The results were moderately sensitive to discount rate, maternal vaccine price, and maternal aP coverage and were robust using the 100 best-fitting parameter sets. Scenarios representing low-income countries showed that maternal aP immunization could be cost-saving in countries with low infant coverage, such as Nigeria, but very expensive in countries, such as Bangladesh, with high infant coverage. ConclusionA dynamic model, which captures the herd immunity benefits of pertussis vaccination, shows that, in low- and middle-income countries, maternal aP immunization is cost-effective when infant vaccination coverage is moderate, even cost-saving when it is low, but not cost-effective when coverage levels pass 90–95%.
Highlights
Pertussis vaccine has been administered for decades worldwide, heterogeneity in coverage and delays in achieving cover-⇑ Corresponding author at: 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of age have been reported [1,2]
We conducted one-way sensitivity analyses to examine the influence of key parameters on the cost-effectiveness results: level of infant vaccination coverage, maternal acellular pertussis (aP) coverage, aP vaccine price for maternal immunization, and discount rate
The dynamic model captures the herd immunity benefits of infant pertussis vaccination and suggests that, if policy makers are willing to spend GDP per capita to avert a disability-adjusted life years (DALYs), maternal aP immunization would be cost-effective in Brazil at recent infant vaccination coverage rates, which have declined from the high rates achieved in the 1990s
Summary
Pertussis vaccine has been administered for decades worldwide, heterogeneity in coverage and delays in achieving cover-. ⇑ Corresponding author at: 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of age have been reported [1,2]. Despite reportedly high infant vaccination coverage, and in addition to its natural cyclical nature, with peaks in disease every 3 to 5 years, resurgent pertussis has been reported in many countries, especially among young infants.
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