title: Cost-benefit of the introduction of new strategies for vaccination against pertussis in Spain: cocooning and pregnant vaccination strategies.
abstract: BACKGROUND
  Pertussis remains a public health problem in countries with high vaccination coverage. Classic vaccination approaches have failed to effectively control the infection. The incidence of pertussis hospitalizations in infants is high, especially in those younger than 3 months who are in high risk of a severe disease and death. Additional strategies are recommended for short-term protection of this vulnerable population. In this study, we estimated the impact of 2 strategies for pertussis prevention in infants younger than 1 year of age-a cocoon vaccination strategy and the vaccination of pregnant women (VPW)-and the cost-benefit of these approaches relative to the current vaccination policy in Spain.
  
  
  METHODS
  A cost-benefit analysis was conducted from the perspective of the publically-funded Spanish healthcare system, based on the yearly number of hospitalizations during the period of 2009 to 2011. We calculated the absolute risk reduction, the number of parents that would need to be vaccinated to prevent 1 hospitalization or death in infants <1 year, and the net benefit-to-cost ratio of each strategy.
  
  
  RESULTS
  From 2009 to 2011, the incidence of pertussis in Spain was 153.44 hospitalizations per 100,000 infants <1 year. The absolute risk reduction for hospitalization would be 42.1/100,000 with cocooning and 75.2/100,000 with VPW. The number of parents needed to vaccinate with the cocoon strategy to prevent 1 pertussis hospitalization would be 4752 and to prevent 1 death, more than 900,000. With VPW, 1331 pregnant women would have to be vaccinated to prevent 1 hospitalization and 200,000 to prevent 1 death. The benefit-to-cost ratio was 0.04 for cocooning and 0.15 for VPW.
authors.affiliation: Nursing Department, Universitat Autònoma de Barcelona, Can Domènech, Edifici M, Campus de la Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain. Electronic address: MariaIsabel.FernandezC@uab.cat.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Fernández-Cano
authors.affiliation: Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Armadans Gil
authors.affiliation: Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
authors.forename: Magda
authors.initials: M
authors.lastname: Campins Martí
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010567:Pertussis Vaccine / Q000008:administration & dosage* / Q000191:economics*; D011247:Pregnancy; D013030:Spain / Q000453:epidemiology; D014611:Vaccination / Q000191:economics* / Q000379:methods*; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D010567:Pertussis Vaccine
keywords: Maternal immunization; Medical economics; Number needed to vaccinate; Pertussis cocoon immunization; Whooping cough