The cost of epidemiological transition: a study of a decrease in pertussis vaccination coverage

Area of Science:

• Epidemiology
• Health Economics
• Vaccinology

Background:

• Pertussis (whooping cough) remains a public health concern, necessitating effective vaccination strategies.
• Evaluating the economic impact of different pertussis vaccination schedules and vaccine types is crucial for resource allocation.

Purpose of the Study:

• To estimate the health and economic consequences of various pertussis vaccination strategies in England and Wales.
• To identify the most cost-effective pertussis prevention strategies considering different vaccine types and coverage levels.

Main Methods:

• A transfer function intervention model was applied to epidemiological data on pertussis incidence and vaccination.
• Economic analysis focused on direct costs of vaccination programs versus the expected costs of pertussis disease.
• Two alternative strategies were compared: whole-cell vs. acellular vaccines for primary courses and boosters.

Main Results:

• Pertussis vaccination programs achieving 90% coverage, especially those with a sixth dose, demonstrated the greatest cost savings for both short-term and long-term prevention.
• Strategies exclusively using acellular vaccines for all doses were generally more expensive.
• Direct costs of 90% vaccination coverage programs were consistently lower than the projected costs of untreated pertussis disease.

Conclusions:

• Maintaining a stable 90% vaccination coverage is the most economically advantageous strategy for pertussis prevention over a 14-year analysis period.
• Decreases in vaccination coverage lead to increased societal costs, with a delayed rise in pertussis cases potentially mitigating some initial cost increases (J-curve effect).
• Sixth-dose pertussis vaccination programs at 90% coverage are recommended for optimal public health and economic outcomes.