title: Should adult tetanus immunization be given as a single vaccination at age 65? A cost-effectiveness analysis.
abstract: OBJECTIVE
  To compare three vaccination strategies for the prevention of adult tetanus. Each strategy includes childhood primary immunization and wound prophylaxis, and one of the following: 1) the currently recommended booster every ten years; 2) a single booster at 65 years of age; or 3) no intervention after age 6 except for wound prophylaxis.
  
  
  METHODS
  Cost-effectiveness analysis was used to compare the three different strategies. A Markov model, cycled annually from age 5 through age 85, was applied to each strategy to predict the incidence and costs of tetanus for the U.S. adult population.
  
  
  RESULTS
  The three strategies have very similar effects on life expectancy but different costs. Expressed incremental to no intervention after childhood primary immunization, the decennial booster strategy is least cost-effective, with a discounted incremental cost-effectiveness ratio of $143,138 per year of life saved compared with $4,527 for the single-booster strategy. Sensitivity analysis demonstrates that the decennial strategy is more effective but more costly over a wide range of model assumptions.
  
  
  CONCLUSIONS
  The current policy of recommending tetanus booster vaccinations every ten years is effective but much more costly than a more easily implemented policy that also provides considerable protection against tetanus. The authors recommend forsaking decennial boosters in favor of a policy of including a single booster at age 65 along with other recommended health maintenance maneuvers reserved for that age.
authors.affiliation: Department of Medicine, Veterans Affairs Medical and Regional Office Center, White River Junction, VT 05009.
authors.forename: D J
authors.initials: DJ
authors.lastname: Balestra
authors.forename: B
authors.initials: B
authors.lastname: Littenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007117:Immunization, Secondary / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D013742:Tetanus / Q000191:economics / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000008:administration & dosage*; D026712:Value of Life
chemical_list: D013745:Tetanus Toxoid