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Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap)
Ana Marli Christovam Sartori1, Patrícia Coelho de Soárez2, Eder Gatti Fernandes2
1Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, ICHC, 4° andar, sala 4028 Cerqueira César, 05403-000 São Paulo, SP, Brazil.
Insights
Introducing universal maternal tetanus-diphtheria-acellular pertussis (Tdap) vaccination in Brazil is a cost-effective strategy to prevent infant pertussis cases and deaths. This intervention significantly saves infant lives and years of life.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Pertussis (whooping cough) incidence has risen in Brazil since 2011, disproportionately affecting infants under 4 months.
- Existing childhood whole-cell pertussis vaccines have not curbed the rising incidence.
Purpose of the Study:
- To assess the cost-effectiveness of integrating universal maternal tetanus-diphtheria-acellular pertussis (Tdap) vaccination into Brazil's National Immunization Program.
- To evaluate the economic impact of maternal Tdap vaccination from both healthcare system and societal perspectives.
Main Methods:
- Economic evaluation using a decision tree model comparing maternal Tdap vaccination with current practices.
- Analysis followed an annual cohort of newborns, utilizing local epidemiological and cost data from Brazilian Health Information Systems.
- Primary outcome measured was cost per life year saved (LYS), with sensitivity analyses performed.
Main Results:
- Universal maternal Tdap vaccination (78% effectiveness, $12.39/dose) would prevent 661 pertussis cases and 24 infant deaths annually.
- This strategy would save 1800 life years, with incremental cost-effectiveness ratios (ICERs) of approximately $15,608 per LYS.
- Sensitivity analysis indicated ICERs are most influenced by discounting, case-fatality rates, disease incidence, vaccine cost, and effectiveness.
Conclusions:
- Universal maternal immunization with Tdap is a cost-effective intervention in Brazil.
- Implementing maternal Tdap vaccination is recommended for preventing infant pertussis.
- The strategy offers significant public health benefits by reducing infant morbidity and mortality from pertussis.
Background:
Pertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil.
Methods:
Economic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed.
Results:
Maternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness.
Conclusion:
The results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
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