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Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis.
Vaccine. 2004 Jul 29; 22(21-22):2953-64.V

Abstract

Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established.

Authors+Show Affiliations

York Health Economics Consortium Ltd., Level 2, Market Square, University of York, YO10 5NH, UK. pas8@york.ac.ukNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15246632

Citation

Scuffham, P A., and P B. McIntyre. "Pertussis Vaccination Strategies for Neonates--an Exploratory Cost-effectiveness Analysis." Vaccine, vol. 22, no. 21-22, 2004, pp. 2953-64.
Scuffham PA, McIntyre PB. Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis. Vaccine. 2004;22(21-22):2953-64.
Scuffham, P. A., & McIntyre, P. B. (2004). Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis. Vaccine, 22(21-22), 2953-64.
Scuffham PA, McIntyre PB. Pertussis Vaccination Strategies for Neonates--an Exploratory Cost-effectiveness Analysis. Vaccine. 2004 Jul 29;22(21-22):2953-64. PubMed PMID: 15246632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis. AU - Scuffham,P A, AU - McIntyre,P B, PY - 2003/07/02/received PY - 2003/11/24/accepted PY - 2004/7/13/pubmed PY - 2004/10/19/medline PY - 2004/7/13/entrez SP - 2953 EP - 64 JF - Vaccine JO - Vaccine VL - 22 IS - 21-22 N2 - Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established. SN - 0264-410X UR - https://www.unboundmedicine.com/medline/citation/15246632/Pertussis_vaccination_strategies_for_neonates__an_exploratory_cost_effectiveness_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264410X04000155 DB - PRIME DP - Unbound Medicine ER -