title: Cost-effectiveness of next-generation vaccines: The case of pertussis.
abstract: Despite steady vaccination coverage rates, pertussis incidence in the United States has continued to rise. This public health challenge has motivated calls for the development of a new vaccine with greater efficacy and duration of protection. Any next-generation vaccine would likely come at a higher cost, and must provide sufficient health benefits beyond those provided by the current vaccine in order to be deemed cost-effective. Using an age-structured transmission model of pertussis, we quantified the health and economic benefits of a next-generation vaccine that would enhance either the efficacy or duration of protection of the childhood series, the duration of the adult booster, or a combination. We developed a metric, the maximum cost-effective price increase (MCPI), to compare the potential value of such improvements. The MCPI estimates the per-dose price increase that would maintain the cost-effectiveness of pertussis vaccination. We evaluated the MCPI across a range of potential single and combined improvements to the pertussis vaccine. As an upper bound, we found that a next-generation vaccine which could achieve perfect efficacy for the childhood series would permit an MCPI of $18 per dose (95% CI: $12-$31). Pertussis vaccine improvements that extend the duration of protection to an average of 75 years would allow for an MCPI of $22 per dose for the childhood series (CI: $10-$33) or $12 for the adult booster (CI: $4-$18). Despite the short duration of the adult booster, improvements to the childhood series could be more valuable than improvements to the adult booster. Combining improvements in both efficacy and duration, a childhood series with perfect efficacy and average duration of 75 years would permit an MCPI of $39 per dose, the highest of any scenario evaluated. Our results highlight the utility of the MCPI metric in evaluating potential vaccines or other interventions when prices are unknown.
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA. Electronic address: meagan.fitzpatrick@yale.edu.
authors.forename: Meagan C
authors.initials: MC
authors.lastname: Fitzpatrick
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Center for Inference and Dynamics of Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Wenzel
authors.affiliation: Santa Fe Institute, Santa Fe, NM, USA.
authors.forename: Samuel V
authors.initials: SV
authors.lastname: Scarpino
authors.affiliation: Santa Fe Institute, Santa Fe, NM, USA; Institute for Disease Modeling, Bellevue, WA, USA; New Mexico State University, Las Cruces, NM, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Althouse
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Atkins
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Townsend
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D007117:Immunization, Secondary / Q000191:economics; D007223:Infant; D008962:Models, Theoretical; D010567:Pertussis Vaccine / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*; D014917:Whooping Cough / Q000517:prevention & control*
chemical_list: D010567:Pertussis Vaccine
keywords: Cost-effectiveness; Mathematical modeling; Pertussis; Price; Vaccine