title: Cost-effectiveness analysis of a pertussis vaccination programme for Japan considering intergenerational infection.
abstract: OBJECTIVE
  The incidence of pertussis in adolescence and adulthood has been increasing, and pertussis outbreaks have occurred sporadically in Japan. The risk of intergenerational infection of pertussis is of concern. The aim of this study is to assess the cost-effectiveness of alternative vaccination programmes for replacing the conventional diphtheria-tetanus (DT) vaccine programme administered in adolescence, considering the risk of intergenerational infection.
  
  
  METHODS
  We examined the cost-effectiveness of 4 pertussis vaccination programmes: (1) one-time adolescent DT vaccination (DT); (2) one-time adolescent DT-acellular pertussis (DTaP) vaccination; (3) one-time adolescent DTaP with decennial booster (DTaP+booster); and (4) one-time adolescent DTaP with additional vaccination targeted at parents with infants (additional DTaP for parents). We adapted a state-transition Markov model to estimate the costs and effectiveness of vaccination in the adolescent and adult cohorts and then considered intergenerational infection from adolescents/adults to infants. We assumed a societal perspective to estimate results and expressed these in terms of cost, life expectancy, quality-adjusted life expectancy, benefit-cost ratio (BCR), and incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  At an incidence of 25 per 100,000, the ICERs of the DTaP and additional DTaP for parents strategies were 3,576,072 JPY and 240,055,273 JPY, respectively, when intergenerational transmission of infection was considered. The ICER for the DTaP+booster strategy was dominated.
  
  
  CONCLUSIONS
  Alternative vaccination programmes are not currently cost-effective. If intergenerational infection considered, one-time adolescent DTaP vaccination is cost-effective. More accurate reports of pertussis incidence are required as the results of cost-effectiveness analyses of vaccination vary greatly depending on incidence.
authors.affiliation: Department of Total Health Promotion Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. itatani@sahs.med.osaka-u.ac.jp
authors.forename: Tomoya
authors.initials: T
authors.lastname: Itatani
authors.forename: Sachiko
authors.initials: S
authors.lastname: Shimizu
authors.forename: Maya
authors.initials: M
authors.lastname: Iwasa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ohkusa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hayakawa
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D022422:Diphtheria-Tetanus Vaccine / Q000191:economics / Q000276:immunology; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000191:economics / Q000276:immunology; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D018803:Models, Economic; D010567:Pertussis Vaccine / Q000191:economics*; D014611:Vaccination; D014917:Whooping Cough / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission
chemical_list: D022422:Diphtheria-Tetanus Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D010567:Pertussis Vaccine