%0 Journal Article
%T Cost-Effectiveness of Tdap Vaccination of Adults Aged ¡Ư65 Years in the Prevention of Pertussis in the US: A Dynamic Model of Disease Transmission
%A Lisa J. McGarry
%A Girishanthy Krishnarajah
%A Gregory Hill
%A Cristina Masseria
%A Michelle Skornicki
%A Narin Pruttivarasin
%A Bhakti Arondekar
%A Julie Roiz
%A Stephen I. Pelton
%A Milton C. Weinstein
%J PLOS ONE
%D 2014
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0072723
%X Objectives In February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ¡Ư65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ¡Ư65 to ¡°baseline¡± practice [full-strength DTaP administered from 2 months to 4¨C6 years, and one dose of Tdap at 11¨C64 years replacing decennial Td booster], using a dynamic model. Methods We constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ¡Ư65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges. Results For the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are $47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios. Conclusions Immunization of eligible adults aged ¡Ư65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0072723