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. 2020 May:134:106066.
doi: 10.1016/j.ypmed.2020.106066. Epub 2020 Mar 19.

Tetanus, diphtheria and acellular pertussis (Tdap) vaccine for prevention of pertussis among adults aged 19 years and older in the United States: A cost-effectiveness analysis

Bo-Hyun Cho  1 , Anna M Acosta  2 , Andrew J Leidner  3 , Amanda E Faulkner  2 , Fangjun Zhou  4
Affiliations

Tetanus, diphtheria and acellular pertussis (Tdap) vaccine for prevention of pertussis among adults aged 19 years and older in the United States: A cost-effectiveness analysis

Bo-Hyun Cho et al. Prev Med. 2020 May.

Abstract

Currently, the Advisory Committee on Immunization Practices recommends one-time tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for all adults 19 years and older. This study is designed to evaluate the cost-effectiveness of Tdap vaccination for Tdap-eligible adults aged 19 through 85 in the United States. A cost-effectiveness model was developed to compute costs and health outcomes associated with pertussis among 100,000 Tdap-eligible persons of each age cohort. From the societal perspective, the cost per quality-adjusted life-year (QALY) saved was evaluated under the vaccination scenarios. Sensitivity analyses were also conducted to evaluate the impacts of changes in key variables. All costs were adjusted to 2018 US$ with an annual discount rate of 3% applied to costs and outcomes. The incremental cost-effectiveness ratios (ICERs) for vaccinating US adults aged 19 to 85 with Tdap ranged from $248,000/QALY to $900,000/QALY. The lowest cost per QALY was found to be $248,000 for the age 65 cohort, followed by $332,000 for the cohort of age 19, and followed by $477,000 for the age 50 cohort. Sensitivity analysis showed the most dramatic changes in ICER occurred when changing the underreporting factor, vaccine effectiveness and vaccination costs. While Tdap vaccination may not be as cost effective as predicted earlier, it remains the best available preventive measure against pertussis. Further investigation of the true burden of pertussis disease among adults and the effectiveness of Tdap vaccination in this population is needed to better estimate the impact of Tdap vaccination.

Keywords: Acellular pertussis; Cost-effectiveness; Reduced diphtheria toxoid; Tdap; Tetanus toxoid; Vaccination; Vaccine.

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Conflict of interest statement

Financial disclosure/Declaration of competing interest

No funding source for disclosure. The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1.
Fig. 1.
Disease progression diagram for pertussis with and without Tdap vaccination of US adults (a) and a diagram of a simple Markov model (b).
Fig. 2.
Fig. 2.
Model results for different ages of US adults receiving Tdap vaccine (a) Cost per QALY saved and (b) components of total program costs.
Fig. 3.
Fig. 3.
Tornado diagrams from the univariate and deterministic sensitivity analysis on selected variables for the cohort of age 19, 50 and 65.
See this image and copyright information in PMC

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