RESUMEN
BACKGROUND: In recent years, notified pertussis cases have been increasingly documented in China. It raised a new public health concern of potential optimization in immunization strategy. This study was aimed to determine the cost-effectiveness of different immunization strategies against pertussis-containing vaccines for 6-year-old pre-school children in Shanghai. METHODS: A Markov-decision tree model was applied to evaluate two pertussis immunization strategies for 6-year-old pre-school children as following: (1) 1 dose of acellular pertussis (aP) contained vaccine (DTaP or Tdap) booster vaccinated at 6 years of age, and (2) no booster at 6 years of age regimen. Primary outcomes included quality-adjusted life years (QALYs), costs, and incremental cost-utility ratios (ICUR). Sensitivity analyses were performed. The analysis was conducted over a study period of 14 years from a societal perspective. RESULTS: Compared to no booster immunization strategy, administering 1 dose of acellular pertussis (aP) contained vaccine (DTaP or Tdap) booster at 6 years of age, resulted in an average cost reduction of CNY 814.16 (USD 116) per individual, an increase in QALYs by 0.00066, and a rise in per capita net monetary benefit (NMB) by CNY 933.51 (USD 132). The total costs over the study period were reduced by CNY 160.59 million (USD 23 million), utility increased by 130.49 QALYs, and NMB increased by CNY 184.14 million (USD 26 million). CONCLUSIONS: Implementing acellular pertussis booster immunization for 6-year-old pre-school children in Shanghai emerges as a cost-saving immunization strategy, with both cost savings and utility gains.
Asunto(s)
Análisis de Costo-Efectividad , Inmunización Secundaria , Años de Vida Ajustados por Calidad de Vida , Tos Ferina , Niño , Femenino , Humanos , Masculino , China/epidemiología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Inmunización Secundaria/economía , Cadenas de Markov , Vacuna contra la Tos Ferina/economía , Vacuna contra la Tos Ferina/administración & dosificación , Vacuna contra la Tos Ferina/inmunología , Vacunación/economía , Vacunación/métodos , Tos Ferina/prevención & control , Tos Ferina/economíaRESUMEN
BACKGROUND: The Canadian National Advisory Committee on Immunization recommends universal vaccination against pertussis in pregnancy. We assessed the cost-effectiveness of vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy in Canada. METHODS: We conducted a cost-utility analysis comparing a vaccination program to no program corresponding with the 2017 Canadian guideline for economic evaluation from the Canadian Agency for Drugs and Technologies in Health. We developed 2 models - part decision tree, part Markov model - to estimate the long-term cost and quality-adjusted life-years (QALYs) for pregnant women and their infants. We obtained epidemiologic data from 2006 to 2015, and derived costs and utility values from relevant sources. Results were reported in 2019 Canadian dollars. We obtained expected values through probabilistic analysis, with methodologic and structural uncertainty assessed through scenario analyses. The analysis adopted an acquisition price of Tdap vaccine of $12.50, with scenario analysis conducted to identify the threshold price for vaccination to be cost-effective. RESULTS: In the base-case scenario, for every 1000 pregnant women vaccinated, the program would lead to a gain of 0.3 QALYs, occurring solely in infants, at an increased total cost of $12 987, or $44 301 per QALY gained. Based on a threshold of $50 000 per QALY gained, vaccination would have been cost-effective in 6 of the 10 years included in the model (range of incremental costs $20 463-$100 348 per QALY gained). The threshold cost for Tdap vaccine to be cost-effective over the 10-year horizon was $14.03. INTERPRETATION: Based on a threshold of $50 000 per QALY gained, vaccination against pertussis in pregnancy would be cost-effective if the acquisition cost per vaccine were $14.03 or less. Province- and territory-specific analyses should be done to inform local decision-making.
Asunto(s)
Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunación/economía , Tos Ferina/prevención & control , Canadá , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Femenino , Humanos , Modelos Económicos , Embarazo , Años de Vida Ajustados por Calidad de VidaRESUMEN
OBJECTIVE: To determine the costs and reimbursement associated with running a vaccine program in 5 obstetrics/gynecology practices in Colorado that had participated in a 3-year randomized, controlled trial focused on increasing vaccination in this setting. MATERIALS AND METHODS: This was a secondary analysis on costs from 5 clinics participating in a cluster-randomized controlled trial that assessed the effectiveness of a multimodal intervention to improve vaccination rates in outpatient obstetrics/gynecology clinics in central Colorado. The intervention included designation of an immunization champion within the practice, purchasing recommended vaccines for the practice, guidance on storage and management, implementing practices for routine identification of eligible patients for vaccination using the medical record, implementation of standing orders for vaccination, and vaccine administration to patients. Data on costs were gathered from office invoices, claims data, surveys and in-person observations during the course of the trial. These data incorporated supply and personnel costs for administering vaccines to individual patients that were derived from a combination of time-motion studies of staff and provider clinical activity, and practice reports, as well as costs related to maintaining the vaccination program at the practice level, which were derived from practice reports and invoices. Cost data for personnel time during visits in which vaccination was assessed and/or discussed, but no vaccine was given to the patient were also included in the main analysis. Data on practice revenue were derived from practice reimbursement records. All costs were described in 2014 dollars. The primary analysis was the proportion of costs for the program that were reimbursed, aggregated over all years of the study and combining all vaccines and practices, separated by obstetrics vs gynecology patients. RESULTS: Collectively the 5 clinics served >40,000 patient during the study period and served a population that was 16% Medicaid. Over the 3-year observation period, there were 6573 vaccination claims made collectively by the practices (4657 for obstetric patients, 1916 for gynecology patients). The most expensive component of the program was the material costs of the vaccines themselves, which ranged from a low of $9.67 for influenza vaccines, to a high of $141.40 for human papillomavirus vaccine. Staff costs for assessing and delivering vaccines during patient visits were minimal ($0.09-$1.24 per patient visit depending on the practice and whether an obstetrics or gynecology visit was being assessed) compared with staff costs for maintaining the program at a practice level (ie, assessing inventory, ordering and stocking vaccines; $0.89-$105.89 per vaccine dose given). When assessing all costs compared with all reimbursement, we found that vaccines for obstetrics patients were reimbursed at 159% of the costs over the study period, and for gynecology patients at 97% of the costs. Overall, the vaccination program was financially favorable across the practices, averaging 125% reimbursement of costs across the three study years. CONCLUSION: Providing routine vaccines to patients in the ambulatory obstetrics/gynecology setting is generally not financially prohibitive for practices, and may even be financially beneficial, though there is variability between practices that can affect the overall reimbursement margin.
Asunto(s)
Atención Ambulatoria/economía , Atención a la Salud/economía , Ginecología/economía , Costos de la Atención en Salud , Programas de Inmunización/economía , Obstetricia/economía , Vacunas/uso terapéutico , Colorado , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/uso terapéutico , Almacenaje de Medicamentos , Determinación de la Elegibilidad , Femenino , Humanos , Vacunas contra la Influenza/economía , Vacunas contra la Influenza/uso terapéutico , Medicaid , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/uso terapéutico , Admisión y Programación de Personal , Ensayos Clínicos Controlados Aleatorios como Asunto , Mecanismo de Reembolso , Población Rural , Factores de Tiempo , Estados Unidos , Población Urbana , Vacunas/economíaRESUMEN
BACKGROUND: Adolescent tetanus, diphtheria and pertussis (Tdap) immunization helps prevent pertussis infection. Timing of Tdap receipt represents an important facet of successful adolescent pertussis immunization. Potential strategies for timing of vaccine administration are each associated with different benefits - including disease prevention - and costs. The objective of this study was to assess the cost-utility of adolescent pertussis immunization strategies in Canada. METHODS: A cost-utility analysis was conducted using a pertussis disease history-simulating Markov model, with adolescents (beginning at age 10 years) as the cohort of interest. The model assessed three Tdap vaccination strategies: (1) immunization of 10 year olds, (2) removal of adolescent vaccination, and (3) immunization of 14 year olds (status quo). The analysis was conducted from a healthcare payer perspective and used a lifetime time horizon. Primary outcomes included life years, quality-adjusted life years (QALYs), health system costs, and an incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at 1.5 percent annually. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS: The current recommended adolescent immunization strategy (at age 14) resulted in an average of 40.4432 expected QALYs and $26.28 per individual. This strategy was dominated by immunization at 10 years and no immunization. Compared to no immunization, immunizing adolescents at age 10 had an ICER of $74,899 per QALY. Results were most sensitive to the incidence of pertussis and the utility of moderate or severe pertussis. At a cost-effectiveness threshold of $50,000/QALY, removal of adolescent vaccination represented the most cost-effective strategy in 78% of simulations. CONCLUSION: Analysis assumes a policy context where immunization of pregnant women is recommended. Findings suggest that alternate adolescent Tdap vaccine strategies - either immunization of 10 year olds, or removal of the adolescent vaccine - are more cost-effective than the current practice of immunizing 14 year olds.
Asunto(s)
Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunación/economía , Tos Ferina , Adolescente , Canadá , Niño , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Humanos , Años de Vida Ajustados por Calidad de Vida , Tos Ferina/prevención & controlRESUMEN
BACKGROUND: A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS: Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20â¯years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10â¯years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS: Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325â¯years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS: The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
Asunto(s)
Análisis Costo-Beneficio/economía , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Programas de Inmunización/economía , Atención de Salud Universal , Adulto , Brasil/epidemiología , Análisis Costo-Beneficio/métodos , Femenino , Humanos , Programas de Inmunización/métodos , Masculino , Adulto JovenRESUMEN
BACKGROUND: In the United States, persons ≥11 years are recommended to receive one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, followed by decennial tetanus- and diphtheria-toxoid (Td) boosters. Many providers use Tdap instead of Td. We evaluated epidemiologic and economic impacts of replacing Td boosters with Tdap. METHODS: We used a static cohort model to examine replacing Td with Tdap over the lifetime of 4,386,854 adults ≥21 years. Because pertussis is underdiagnosed and true incidence is unknown, we varied incidence from 2.5 cases/100,000 person-years to 500 cases/100,000 person-years. We calculated vaccine and medical costs from claims data. We estimated cost per case prevented and per quality-adjusted life year (QALY) saved; sensitivity analyses were conducted on vaccine effectiveness (VE), protection duration, vaccine cost, disease duration, hospitalization rates, productivity loss and missed work. We did not include programmatic advantages resulting from use of a single tetanus-toxoid containing vaccine. RESULTS: At lowest incidence estimates, administering Tdap resulted in high costs per averted case ($111,540) and QALY saved ($8,972,848). As incidence increased, cases averted increased and cost per QALY saved decreased rapidly. With incidence estimates of 250 cases/100,000 person-years, cost per averted case and QALY saved were $984 and $81,678 respectively; at 500 cases/100,000 person-years, these values were $427 and $35,474. In multivariate sensitivity analyses, assuming 250 cases/100,000 person-years, estimated cost per QALY saved ranged from $971 (most favorable) to $217,370 (least favorable). CONCLUSIONS: Our findings suggest that replacing Td with Tdap for the decennial booster would result in high cost per QALY saved based on reported cases. However, programmatic considerations were not accounted for, and if pertussis incidence, which is incompletely measured, is assumed to be higher than reported through national surveillance, substituting Tdap for Td may lead to moderate decreases in pertussis cases and cost per QALY.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Hospitalización/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Vacunación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Difteria/economía , Difteria/prevención & control , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Humanos , Inmunización Secundaria , Persona de Mediana Edad , Tétanos/economía , Tétanos/prevención & control , Estados Unidos , Vacunación/economía , Tos Ferina/economía , Tos Ferina/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Despite excellent vaccine coverage, pertussis persists in Canada, with high incidence during recent outbreaks and non-negligible incidence in non-outbreak years. While Canadian pertussis incidence is well-characterized, the full health and economic impact of pertussis have not been examined in Canada. We estimated age-specific life years (LYs) and quality-adjusted life years (QALYs) lost, and costs due to pertussis in Ontario, Canada, using a model-based approach. METHODS: We developed a microsimulation model to simulate pertussis natural history. Daily probabilities of pertussis complications, hospitalizations, and disease sequelae as well as utilities and costs for health states were literature-derived. A healthcare payer perspective was used with a lifetime time horizon. Model outcomes were compared to those from a model with no pertussis health states. Probabilistic sensitivity analyses were used to generate distributions for estimates. Economic burden was estimated by multiplying case cost estimates by annual age-specific incidence. RESULTS: Overall, LYs lost per pertussis case was low, with negligible LYs lost in those aged >4â¯years. Infants (<6 months) had the greatest mean QALY loss per case (0.58), while adults lost only 0.05 QALYs per case. Infants experienced the greatest mean cost per case of $22,768 (95% CI: 21,144-23,406). Case costs generally declined with age, but increased in seniors (aged 65+) with mean cost of $1920 (95% CI: 1800-2033). Based on historic age-specific incidence, pertussis costs the Ontario healthcare system approximately $7.6-$21.5â¯M annually. In total economic cost estimates with QALYs valued at 1xGDP (3xGDP) per capita, the net impact of pertussis in Ontario was estimated at $21.7-$66.5â¯M annually ($50.0-$156.3â¯M). For all of Canada, total economic costs were estimated at $79.6-$241.3â¯M ($187.5-$580.5â¯M) annually. CONCLUSION: The health and economic consequences of pertussis persistence are substantial and highlight the need for improved control strategies.
Asunto(s)
Costo de Enfermedad , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Costos de la Atención en Salud/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Tos Ferina/economía , Tos Ferina/epidemiología , Adolescente , Adulto , Anciano , Canadá/epidemiología , Niño , Preescolar , Simulación por Computador , Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Modelos Económicos , Ontario/epidemiología , Vacunación/economía , Adulto JovenRESUMEN
INTRODUCTION: Financial concerns are frequently cited by providers as a barrier to adult vaccination. This study assessed insurance reimbursements to providers for administering vaccines to adults in the private sector. METHODS: This study, conducted in 2018, used the 2016 MarketScan Commercial Claims and Encounters Database and included vaccination visits made by adults aged 19-64 years. Four routinely recommended vaccines targeted at adults were included: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); tetanus and diphtheria toxoids (Td); zoster; and influenza. The mean reimbursements for vaccine purchase and administration were reported and examined by state, metropolitan statistical area, provider type, and insurance plan type. Using the private vaccine purchase price published by the Centers for Disease Control and Prevention (CDC), the study reported the proportion of vaccination visits receiving reimbursements above the CDC-published price. RESULTS: The mean vaccine administration reimbursement was $25.80 for the first dose and $14.71 for additional doses in the same visit. The mean vaccine purchase reimbursement was $44.15 for Tdap, $25.78 for Td, and $216.05 for the zoster vaccine; the unweighted mean for the four examined influenza vaccines was $17.25. Reimbursements varied widely by state. Vaccine reimbursements exceeded the CDC-published price for most visits where Tdap (71.4%), zoster (87.8%), and three of four influenza (61.5%-88.5%) vaccines were administered but only for 25.8% of visits where Td was given. CONCLUSIONS: On average, reimbursements for administering vaccines to privately insured adults were adequate for most private practices. However, providers' financial concerns may vary across geographic locations.
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Vacuna contra Difteria y Tétanos/economía , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacuna contra el Herpes Zóster/economía , Vacunas contra la Influenza/economía , Revisión de Utilización de Seguros , Sector Privado , Vacunación , Adulto , Bases de Datos Factuales , Vacuna contra Difteria y Tétanos/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Femenino , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Vacunas contra la Influenza/administración & dosificación , Revisión de Utilización de Seguros/economía , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
Pertussis vaccination of parents and household contacts ('cocooning') to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged ≤6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was 'reduction in source of infection' in Spain (23.1%) and 'vaccination location' in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89-98%; applying vaccine costs (25 per person) would reduce the probability of uptake by 7-20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option.
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Toma de Decisiones , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Padres/psicología , Vacunación/psicología , Tos Ferina/prevención & control , Adulto , Anciano , Estudios Transversales , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Femenino , Humanos , Recién Nacido , Italia , Masculino , Persona de Mediana Edad , España , Tos Ferina/transmisión , Adulto JovenRESUMEN
INTRODUCTION: The Advisory Committee on Immunization Practices (ACIP) has focused on maternal Tdap immunization as an important means to protect neonates from pertussis infections. There is little published data on provider and/or clinic characteristics as predictors of maternal Tdap uptake. This study examined differences in maternal Tdap coverage in women delivering at a single academic institution, but cared for prenatally in different clinical settings, in 2013, 2014, and 2015. Additionally, the accuracy and utilization of Vermont's immunization information system (IIS) was assessed. METHODS: This was a retrospective, multiple time-point cross-sectional analysis of annual maternal Tdap coverage in women delivering at a single academic institution in the 3â¯years following a fundamental change in national maternal Tdap vaccination guidelines. Tdap administration was examined across different obstetric groups using chart review and data from the state's IIS. RESULTS: All obstetric care groups except the resident-staffed clinic significantly increased maternal Tdap coverage in 2014, compared to 2013 coverage, with no further increase in 2015. In contrast, there was no increase in maternal Tdap coverage in 2014 in the resident-staffed clinics, but then a statistically significant increase in 2015. Overall Tdap coverage in 2014 was 80.4%, with variation in Tdap coverage between clinics types. In the subset of women who were cared for by the University-based groups, there was significant variation in Tdap coverage between clinics, despite racial homogeneity, which persisted after adjustment for maternal age and insurance type. The state's IIS was found to be highly accurate, using individual chart review as the "gold standard." DISCUSSION: While we demonstrated high maternal Tdap coverage in women delivering at our institution, differences in clinic type and provider training appeared to impact immunization rates, as well as how quickly evolving national recommendations were adopted. Additionally, the fidelity of the state's IIS data was verified.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Beneficios del Seguro/estadística & datos numéricos , Servicios de Salud para Estudiantes/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Tos Ferina/prevención & control , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Estudios Transversales , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Femenino , Humanos , Beneficios del Seguro/normas , Embarazo , Mujeres Embarazadas , Estudios Retrospectivos , Vermont , Adulto JovenRESUMEN
The reemergence of pertussis in the last two decades led to the introduction of adolescents and adults immunization strategies of tetanus-diphtheria-acellular pertussis vaccines (Tdap) in several countries. The health authorities must consider economic aspects when deciding to recommend and fund new programs. Here we present a systematic review of worldwide full economic evaluations of pertussis vaccination targeting adolescents or adults published from 2000. Studies were identified by searching MEDLINE, Excerpta Medica, CRD, and Lilacs databases. Twenty-seven economic evaluations of different strategies with Tdap were identified. Booster vaccination for adolescents and adults were the most frequent, followed by cocooning and pregnant women vaccination. Strategies performance varied considerably among different studies. Assumptions regarding underreporting correction, herd protection and vaccine coverage were crucial to cost-effectiveness results. Understanding the model and the parameters used is essential to understand the results, and identify the major issues important to public health decisions.
Asunto(s)
Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacunación/economía , Tos Ferina/prevención & control , Adolescente , Adulto , Factores de Edad , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Femenino , Humanos , Inmunización Secundaria , Salud Materna , EmbarazoRESUMEN
BACKGROUND: Both re-emergence of pertussis outbreak among adolescents/adults and recent approval of the extended use of DTaP vaccine for boosting adolescents/adults against pertussis in Japan, have raised the possibility of using aP-containing vaccine in pregnant women to protect neonates and unvaccinated infants. There is a need, therefore, to evaluate the value for money of such possibility. METHODS: We evaluated the cost-effectiveness of conducting antepartum maternal vaccination (AMV) strategy in Japan. Considering the duration of vaccine effectiveness for infant (single year) and for mother (multiple years), the decision tree model and Markov model was adapted for infant and mother, respectively. Incremental cost-effectiveness ratio (ICER) compared with current no AMV strategy from societal perspective were calculated. The transition probabilities, utility weights to estimate quality-adjusted life year (QALY), and disease treatment costs were either calculated or extracted from literature. Costs per vaccination was assumed at ¥6000/US$54.5. Markov model for mothers with one-year cycle runs up to year four after vaccination, based on the waning of vaccine effectiveness. Infant who survived from pertussis was assumed to live until to his/her life expectancy. RESULTS: AMV strategy reduces disease treatment costs, while the reduction cannot offset the vaccination cost. Incremental QALYs were at 0.0002802, among them 79.5% were from infants, and others from mothers. ICER was ¥9,149,317/US$83,176 per QALY gained. One-way sensitivity analyses identified that the incidence rate and costs per shot were the two main key variables to impact the ICER. CONCLUSION: We found that vaccinating pregnant women with aP-containing vaccine to prevent neonatal and unvaccinated infants from pertussis-associated disease in Japan can be cost-effective from societal perspective, under the WHO-suggested "cost-effective" criteria (1 to 3 times of GDP). Pertussis is expected be designated as a notifiable disease in 2018, re-analysis should be conducted when straightforward incidence data is available.
Asunto(s)
Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacunación/economía , Tos Ferina/prevención & control , Árboles de Decisión , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Femenino , Costos de la Atención en Salud , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Masculino , Cadenas de Markov , Modelos Económicos , Embarazo , Años de Vida Ajustados por Calidad de Vida , Vacunación/estadística & datos numéricos , Tos Ferina/epidemiologíaRESUMEN
INTRODUCTION: U.S. obstetrician/gynecologists play a critical role as vaccinators of pregnant women. However, little is known about their current immunization practices. Thus, study objectives were to determine (1) practices related to assessment of vaccination status and vaccine delivery for pregnant patients; (2) barriers to stocking and administering vaccines; and (3) factors associated with administering both influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. METHODS: An e-mail and mail survey among a national sample of obstetrician/gynecologists conducted July-October 2015 (analysis August 2016-August 2017). RESULTS: The response rate was 73.2% (353/482). Among obstetrician/gynecologists caring for pregnant women (n=324), vaccination status was most commonly assessed for influenza (97%), Tdap (92%), and measles, mumps, and rubella vaccines (88%). Vaccines most commonly administered included influenza (85%) and Tdap (76%). Few respondents reported administering other vaccines to pregnant patients. More physicians reported using standing orders for influenza (66%) than Tdap (39%). Other evidence-based strategies for increasing vaccine uptake were less frequently used (electronic decision support, 42%; immunization information system to record [13%] or assess vaccination status [11%]; reminder/recall, 7%). Barriers most commonly reported were provider financial barriers, yet provider attitudinal barriers were rare. Providers who administered both influenza and Tdap vaccines were more likely to be female, perceive fewer financial and practice barriers, less likely to be in private practice, and perceive more patient barriers. CONCLUSIONS: Although most obstetrician/gynecologists administer some vaccines to pregnant women, the focus remains on influenza and Tdap. Financial barriers and infrequent use of evidence-based strategies for increasing vaccination uptake may be hindering delivery of a broader complement of adult vaccines in obstetrician/gynecologist offices.
Asunto(s)
Ginecología/organización & administración , Obstetricia/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación/estadística & datos numéricos , Adulto , Difteria/prevención & control , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/organización & administración , Medicina Basada en la Evidencia/estadística & datos numéricos , Femenino , Ginecología/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Humanos , Programas de Inmunización/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Obstetricia/estadística & datos numéricos , Embarazo , Tétanos/prevención & control , Estados Unidos , Vacunación/economía , Tos Ferina/prevención & controlRESUMEN
OBJECTIVE: To assess the relationship between copay amount and vaccination claim submission status for tetanus-diphtheria-acellular pertussis (Tdap) and herpes zoster (GSK study identifier: HO-14-14319). METHODS: Retrospective analyses were performed using vaccination administrative claims data in patients aged ≥65 years with ≥1 claim for Tdap or zoster vaccines between 2012 and 2014. To avoid confounding by other financial responsibility, analyses were conducted among patients in the copayment phase of insurance. The impact of patient copay amount on vaccination claim status ("canceled" vs. "paid") was evaluated by logistic regression separately for Tdap and zoster, adjusting for patient and provider characteristics. RESULTS: A total of 81,027 (39.2% with canceled claims) and 346,417 patients (56.8% with canceled claims) were included in the Tdap and zoster analyses, respectively. Mean (standard deviation) copay for canceled vs. paid claims was $37.2 (18.4) vs. $31.1 (20.1) for Tdap and $64.9 (36.9) vs. $53.5 (38.8) for zoster. The adjusted odds ratios (ORs) for a canceled Tdap vaccine claim, compared with $0 copay, were 1.19 ($1-25 copay), 1.76 ($26-50 copay), 2.42 ($51-75 copay) and 2.40 ($76-100 copay), all p < .001. The adjusted ORs for a canceled zoster vaccine claim, compared with $0 copay, were 1.02 ($1-25), 1.39 ($26-50), 1.66 ($51-75), 2.07 ($76-100) and 2.71 (>$100), all p < .001 except for $1-25 (p = .172). CONCLUSIONS: High patient copay is a barrier to Tdap and zoster vaccinations in Medicare Part D patients. Providing vaccines at low or no copay may improve vaccination rates in these adults. GSK study identifier: HO-14-14319.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacuna contra el Herpes Zóster/economía , Medicare Part D/economía , Vacunación , Anciano , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Revisión de Utilización de Seguros , Estudios Retrospectivos , Estados Unidos/epidemiología , Vacunación/economía , Vacunación/estadística & datos numéricosRESUMEN
The cost-effectiveness of the 4 Pillars™ Practice Transformation Program to improve vaccination rates in adults <65-years-old is unknown. Two vaccines, influenza and Tdap (tetanus, diphtheria, acellular pertussis), were targeted for this age group. Cost-effectiveness of the intervention compared with control, with a primary outcome of cost per quality adjusted life year (QALY) gained, was estimated from societal and third party payer perspectives over a 10-year time horizon using a decision analysis model. Vaccination rates and intervention costs were derived from an intervention trial, and vaccine effectiveness, illness rates, and costs with/without vaccination were obtained from US databases and literature data. Future costs and effectiveness were discounted at 3%/year. The intervention cost was $1.78 per eligible patient/year. From the societal perspective, per patient total vaccination and illness costs with the intervention were $27.43 higher than control while gaining 0.00087 QALYs, costing $31,700/QALY gained. The intervention, extrapolated to the US population, could prevent 4.2 million cases, 87,489 hospitalizations, and 5,680 deaths due to influenza over 10 y in adults <65-years-old. In a probabilistic sensitivity analysis, the intervention was favored in 68.2% of model runs at a $50,000/QALY level and in 94.3% at $100,000/QALY. In a separate scenario analysis, the intervention became cost saving if influenza economic burden was >$2,099 per case (societal base case $846). Thus, the 4 Pillars Practice Transformation Program is an economically reasonable intervention to improve vaccination rates in adults <65-years-old, and could have a substantial public health impact.
Asunto(s)
Vacuna contra Difteria y Tétanos/economía , Programas de Inmunización , Vacunas contra la Influenza , Cobertura de Vacunación , Vacunación/economía , Adulto , Análisis Costo-Beneficio , Bases de Datos Factuales , Técnicas de Apoyo para la Decisión , Difteria/prevención & control , Vacuna contra Difteria y Tétanos/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Humanos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Persona de Mediana Edad , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Tétanos/prevención & control , Estados UnidosRESUMEN
OBJECTIVES: To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. DESIGN: Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. SETTING: Diverse primary care practices in two U.S. cities. PARTICIPANTS: Clinical trial participants aged 65 and older. MEASUREMENTS: Quality-adjusted life years (QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions. RESULTS: With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained. CONCLUSIONS: Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Programas de Inmunización/economía , Vacunas contra la Influenza/economía , Vacunas Neumococicas/economía , Anciano , Análisis Costo-Beneficio , Femenino , Humanos , Gripe Humana/economía , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Masculino , Cadenas de Markov , Pennsylvania/epidemiología , Infecciones Neumocócicas/economía , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Años de Vida Ajustados por Calidad de Vida , Texas/epidemiología , Estados Unidos/epidemiología , Tos Ferina/economía , Tos Ferina/epidemiología , Tos Ferina/prevención & controlRESUMEN
Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Tos Ferina/prevención & control , Adulto , Factores de Edad , Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Femenino , Humanos , Esquemas de Inmunización , Lactante , Recién Nacido , Modelos Econométricos , Embarazo , Años de Vida Ajustados por Calidad de Vida , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: We described the following among U.S. primary care physicians: (1) perceived importance of vaccines recommended by the Advisory Committee on Immunization Practices relative to U.S. Preventive Services Task Force (USPSTF) preventive services, (2) attitudes toward the U.S. adult immunization schedule, and (3) awareness and use of Medicare preventive service visits. METHODS: We conducted an Internet and mail survey from March to June 2012 among national networks of general internists and family physicians. RESULTS: We received responses from 352 of 445 (79%) general internists and 255 of 409 (62%) family physicians. For a 67-year-old hypothetical patient, 540/606 (89%, 95% confidence interval [CI] 87, 92) of physicians ranked seasonal influenza vaccine and 487/607 (80%, 95% CI 77, 83) ranked pneumococcal vaccine as very important, whereas 381/604 (63%, 95% CI 59, 67) ranked Tdap/Td vaccine and 288/607 (47%, 95% CI 43, 51) ranked herpes zoster vaccine as very important (p<0.001). All Grade A USPSTF recommendations were considered more important than Tdap/Td and herpes zoster vaccines. For the hypothetical patient aged 30 years, the number and percentage of physicians who reported that the Tdap/Td vaccine (377/604; 62%, 95% CI 59, 66) is very important was greater than the number and percentage who reported that the seasonal influenza vaccine (263/605; 43%, 95% CI 40, 47) is very important (p<0.001), and all Grade A and Grade B USPSTF recommendations were more often reported as very important than was any vaccine. A total of 172 of 587 physicians (29%) found aspects of the adult immunization schedule confusing. Among physicians aware of "Welcome to Medicare" and annual wellness visits, 492/514 (96%, 95% CI 94, 97) and 329/496 (66%, 95% CI 62, 70), respectively, reported having conducted fewer than 10 such visits in the previous month. CONCLUSIONS: Despite lack of prioritization of vaccines by ACIP, physicians are prioritizing some vaccines over others and ranking some vaccines below other preventive services. These attitudes and confusion about the immunization schedule may result in missed opportunities for vaccination. Medicare preventive visits are not being used widely despite offering a venue for delivery of preventive services, including vaccinations.
Asunto(s)
Actitud del Personal de Salud , Esquemas de Inmunización , Seguro de Salud/legislación & jurisprudencia , Médicos de Atención Primaria/psicología , Servicios Preventivos de Salud/legislación & jurisprudencia , Vacunas/normas , Adulto , Anciano , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/normas , Femenino , Adhesión a Directriz/estadística & datos numéricos , Encuestas de Atención de la Salud , Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/economía , Vacuna contra el Herpes Zóster/normas , Humanos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Vacunas contra la Influenza/normas , Cobertura del Seguro/economía , Cobertura del Seguro/legislación & jurisprudencia , Seguro de Salud/economía , Masculino , Medicare/economía , Medicare/legislación & jurisprudencia , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/economía , Vacunas Neumococicas/normas , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/métodos , Estados Unidos , Vacunas/administración & dosificación , Vacunas/economíaRESUMEN
BACKGROUND: Pertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil. METHODS: Economic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed. RESULTS: Maternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness. CONCLUSION: The results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
Asunto(s)
Análisis Costo-Beneficio , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/uso terapéutico , Vacunación/economía , Brasil , Difteria/prevención & control , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/economía , Femenino , Hospitalización/economía , Humanos , Inmunidad Materno-Adquirida , Programas de Inmunización/economía , Lactante , Recién Nacido , Modelos Económicos , Embarazo , Tétanos/prevención & control , Tos Ferina/prevención & controlRESUMEN
INTRODUCTION: The United States experienced a substantial increase in reported pertussis cases over the last decade. Since 2005, persons 11 years and older have been routinely recommended to receive a single dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine. The objective of this analysis was to evaluate the potential impact and cost-effectiveness of recommending a second dose of Tdap. METHODS: A static cohort model was used to calculate the epidemiologic and economic impact of adding a second dose of Tdap at age 16 or 21 years. Projected costs and outcomes were examined from a societal perspective over a 20-year period. Quality-adjusted Life Years (QALY) saved were calculated. RESULTS: Using baseline pertussis incidence from the National Notifiable Diseases Surveillance System, Tdap revaccination at either age 16 or 21 years would reduce outpatient visits by 433 (5%) and 285 (4%), and hospitalization cases by 7 (7%) and 5 (5%), respectively. The costs per QALY saved with a second dose of Tdap were approximately US $19.7 million (16 years) and $26.2 million (21 years). In sensitivity analyses, incidence most influenced the model; as incidence increased, the costs per QALY decreased. To a lesser degree, initial vaccine effectiveness and waning of effectiveness also affected cost outcomes. Multivariate sensitivity analyses showed that under a set of optimistic assumptions, the cost per QALY saved would be approximately $163,361 (16 years) and $204,556 (21 years). CONCLUSION: A second dose of Tdap resulted in a slight decrease in the number of cases and other outcomes, and that trend is more apparent when revaccinating at age 16 years than at age 21 years. Both revaccination strategies had high dollar per QALY saved even under optimistic assumptions in a multivariate sensitivity analysis.