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Economic impact of implementing decennial tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination in adults in the United States.
Vaccine. 2020 01 10; 38(2):380-387.V

Abstract

BACKGROUND

In the United States, persons ≥11 years are recommended to receive one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, followed by decennial tetanus- and diphtheria-toxoid (Td) boosters. Many providers use Tdap instead of Td. We evaluated epidemiologic and economic impacts of replacing Td boosters with Tdap.

METHODS

We used a static cohort model to examine replacing Td with Tdap over the lifetime of 4,386,854 adults ≥21 years. Because pertussis is underdiagnosed and true incidence is unknown, we varied incidence from 2.5 cases/100,000 person-years to 500 cases/100,000 person-years. We calculated vaccine and medical costs from claims data. We estimated cost per case prevented and per quality-adjusted life year (QALY) saved; sensitivity analyses were conducted on vaccine effectiveness (VE), protection duration, vaccine cost, disease duration, hospitalization rates, productivity loss and missed work. We did not include programmatic advantages resulting from use of a single tetanus-toxoid containing vaccine.

RESULTS

At lowest incidence estimates, administering Tdap resulted in high costs per averted case ($111,540) and QALY saved ($8,972,848). As incidence increased, cases averted increased and cost per QALY saved decreased rapidly. With incidence estimates of 250 cases/100,000 person-years, cost per averted case and QALY saved were $984 and $81,678 respectively; at 500 cases/100,000 person-years, these values were $427 and $35,474. In multivariate sensitivity analyses, assuming 250 cases/100,000 person-years, estimated cost per QALY saved ranged from $971 (most favorable) to $217,370 (least favorable).

CONCLUSIONS

Our findings suggest that replacing Td with Tdap for the decennial booster would result in high cost per QALY saved based on reported cases. However, programmatic considerations were not accounted for, and if pertussis incidence, which is incompletely measured, is assumed to be higher than reported through national surveillance, substituting Tdap for Td may lead to moderate decreases in pertussis cases and cost per QALY.

Authors+Show Affiliations

Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States. Electronic address: fhavers@cdc.gov.Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.Department of Epidemiology, College of Public Health, University of Georgia, Athens, GA, United States.Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

31676198

Citation

Havers, Fiona P., et al. "Economic Impact of Implementing Decennial Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccination in Adults in the United States." Vaccine, vol. 38, no. 2, 2020, pp. 380-387.
Havers FP, Cho BH, Walker JW, et al. Economic impact of implementing decennial tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination in adults in the United States. Vaccine. 2020;38(2):380-387.
Havers, F. P., Cho, B. H., Walker, J. W., & Hariri, S. (2020). Economic impact of implementing decennial tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination in adults in the United States. Vaccine, 38(2), 380-387. https://doi.org/10.1016/j.vaccine.2019.09.104
Havers FP, et al. Economic Impact of Implementing Decennial Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccination in Adults in the United States. Vaccine. 2020 01 10;38(2):380-387. PubMed PMID: 31676198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic impact of implementing decennial tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination in adults in the United States. AU - Havers,Fiona P, AU - Cho,Bo-Hyun, AU - Walker,Joseph W, AU - Hariri,Susan, Y1 - 2019/10/31/ PY - 2019/06/25/received PY - 2019/09/06/revised PY - 2019/09/30/accepted PY - 2019/11/5/pubmed PY - 2021/2/10/medline PY - 2019/11/3/entrez KW - Adult KW - Cost-effectiveness KW - Pertussis KW - Tdap KW - Vaccination KW - Whooping cough SP - 380 EP - 387 JF - Vaccine JO - Vaccine VL - 38 IS - 2 N2 - BACKGROUND: In the United States, persons ≥11 years are recommended to receive one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, followed by decennial tetanus- and diphtheria-toxoid (Td) boosters. Many providers use Tdap instead of Td. We evaluated epidemiologic and economic impacts of replacing Td boosters with Tdap. METHODS: We used a static cohort model to examine replacing Td with Tdap over the lifetime of 4,386,854 adults ≥21 years. Because pertussis is underdiagnosed and true incidence is unknown, we varied incidence from 2.5 cases/100,000 person-years to 500 cases/100,000 person-years. We calculated vaccine and medical costs from claims data. We estimated cost per case prevented and per quality-adjusted life year (QALY) saved; sensitivity analyses were conducted on vaccine effectiveness (VE), protection duration, vaccine cost, disease duration, hospitalization rates, productivity loss and missed work. We did not include programmatic advantages resulting from use of a single tetanus-toxoid containing vaccine. RESULTS: At lowest incidence estimates, administering Tdap resulted in high costs per averted case ($111,540) and QALY saved ($8,972,848). As incidence increased, cases averted increased and cost per QALY saved decreased rapidly. With incidence estimates of 250 cases/100,000 person-years, cost per averted case and QALY saved were $984 and $81,678 respectively; at 500 cases/100,000 person-years, these values were $427 and $35,474. In multivariate sensitivity analyses, assuming 250 cases/100,000 person-years, estimated cost per QALY saved ranged from $971 (most favorable) to $217,370 (least favorable). CONCLUSIONS: Our findings suggest that replacing Td with Tdap for the decennial booster would result in high cost per QALY saved based on reported cases. However, programmatic considerations were not accounted for, and if pertussis incidence, which is incompletely measured, is assumed to be higher than reported through national surveillance, substituting Tdap for Td may lead to moderate decreases in pertussis cases and cost per QALY. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/31676198/Economic_impact_of_implementing_decennial_tetanus_toxoid_reduced_diphtheria_toxoid_and_acellular_pertussis__Tdap__vaccination_in_adults_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(19)31348-9 DB - PRIME DP - Unbound Medicine ER -