title: Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis.
abstract: Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established.
authors.affiliation: York Health Economics Consortium Ltd., Level 2, Market Square, University of York, YO10 5NH, UK. pas8@york.ac.uk
authors.forename: P A
authors.initials: PA
authors.lastname: Scuffham
authors.forename: P B
authors.initials: PB
authors.lastname: McIntyre
mesh_terms: D000465:Algorithms; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy; D008390:Markov Chains; D015233:Models, Statistical; D009010:Monte Carlo Method; D010290:Parents; D010342:Patient Acceptance of Health Care; D010567:Pertussis Vaccine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014917:Whooping Cough / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D010567:Pertussis Vaccine