Tetanus, diphtheria and acellular pertussis (Tdap) vaccine for prevention of pertussis among adults aged 19 years and older in the United States: A cost-effectiveness analysis

• Published in: Preventive medicine Vol. 134; p. 106066
• Main Authors: Cho, Bo-Hyun, Acosta, Anna M., Leidner, Andrew J., Faulkner, Amanda E., Zhou, Fangjun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2020
• Subjects: Acellular pertussis; Adult; Aged; Aged, 80 and over; Cohort Studies; Cost-Benefit Analysis; Cost-effectiveness; Diphtheria-Tetanus-acellular Pertussis Vaccines - administration & dosage; Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology; Female; Humans; Middle Aged; Quality-Adjusted Life Years; Reduced diphtheria toxoid; Tdap; Tetanus toxoid; United States; Vaccination; Vaccination - statistics & numerical data; Vaccine; Whooping Cough - prevention & control; United States; Reduced diphtheria toxoid; Vaccination; Tetanus toxoid; Tdap; Vaccine; Cost-effectiveness; Acellular pertussis
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2020.106066

Currently, the Advisory Committee on Immunization Practices recommends one-time tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for all adults 19 years and older. This study is designed to evaluate the cost-effectiveness of Tdap vaccination for Tdap-eligible adults aged 19 through 85 in the United States. A cost-effectiveness model was developed to compute costs and health outcomes associated with pertussis among 100,000 Tdap-eligible persons of each age cohort. From the societal perspective, the cost per quality-adjusted life-year (QALY) saved was evaluated under the vaccination scenarios. Sensitivity analyses were also conducted to evaluate the impacts of changes in key variables. All costs were adjusted to 2018 US$ with an annual discount rate of 3% applied to costs and outcomes. The incremental cost-effectiveness ratios (ICERs) for vaccinating US adults aged 19 to 85 with Tdap ranged from $248,000/QALY to $900,000/QALY. The lowest cost per QALY was found to be $248,000 for the age 65 cohort, followed by $332,000 for the cohort of age 19, and followed by $477,000 for the age 50 cohort. Sensitivity analysis showed the most dramatic changes in ICER occurred when changing the underreporting factor, vaccine effectiveness and vaccination costs. While Tdap vaccination may not be as cost effective as predicted earlier, it remains the best available preventive measure against pertussis. Further investigation of the true burden of pertussis disease among adults and the effectiveness of Tdap vaccination in this population is needed to better estimate the impact of Tdap vaccination.
•The cost-effectiveness ratios for Tdap vaccination for US adults ranged from $248,000/QALY to $900,000/QALY.•The ICER was found to be $248,000 for the age 65 followed by $332,000 for the age 19 and $477,000 for the age 50 cohort.•The under-reporting factor, vaccine effectiveness and vaccination costs were the most influential factors to the ICER.•Further investigation of the burden of pertussis incidences and the effectiveness of Tdap vaccines among adults is needed.