title: Use of models to identify cost-effective interventions: pertussis vaccination for pediatric health care workers.
abstract: OBJECTIVE
  Acellular pertussis vaccine is safe and effective in adults. An explicit recommendation for pertussis booster vaccination in pediatric health care workers is based on the importance of health care workers as a potential source of infection for patients. However, limited information is available on the economic attractiveness of this intervention. We sought to evaluate the health-economic attractiveness of a diphtheria-tetanus-acellular pertussis booster vaccination program for health care workers in a pediatric intensive care setting.
  
  
  METHODS
  We developed a Markov model to calculate the cost-effectiveness of vaccinating NICU health care workers in different proportions ranging from the current strategy of no pertussis booster vaccination program to a vaccination program that achieves between 25% and 95% vaccine coverage.
  
  
  RESULTS
  Implementation of a vaccination program that achieves 25% coverage was projected to be cost-saving compared with no vaccine program. At all coverage levels the intervention reduced costs, increased life expectancy, and was cost-effective. Projections were most sensitive to the risk of a pertussis introduction via an infected health care worker. Once the monthly risk of an introduction exceeded ∼0.3%, implementation of an immunization program with at least 25% coverage provided both greater health and greater economic benefits than having no vaccine program.
  
  
  CONCLUSIONS
  The implementation of a hospital-based and funded diphtheria-tetanus-acellular pertussis vaccine program administered through an occupational health program is cost-effective or cost-saving in the context of pediatric health care facilities in which many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized.
authors.affiliation: Public Health Agency of Canada, 180 Queen St W, 11th floor, Toronto, Ontario, Canada M5V 3L7. amy.greer@phac.aspc.gc.ca
authors.forename: Amy L
authors.initials: AL
authors.lastname: Greer
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D009784:Occupational Diseases / Q000191:economics / Q000517:prevention & control*; D009864:Ontario; D019057:Quality-Adjusted Life Years; D013269:Stochastic Processes; D014917:Whooping Cough / Q000191:economics / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines