Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSARTORI, Ana Marli Christovam
dc.contributor.authorSOAREZ, Patricia Coelho de
dc.contributor.authorFERNANDES, Eder Gatti
dc.contributor.authorGRYNINGER, Ligia Castellon Figueiredo
dc.contributor.authorVISCONDI, Juliana Yukari Kodaira
dc.contributor.authorNOVAES, Hillegonda Maria Dutilh
dc.date.accessioned2016-07-18T12:13:13Z
dc.date.available2016-07-18T12:13:13Z
dc.date.issued2016
dc.description.abstractBackground: 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.
dc.description.indexMEDLINE
dc.description.sponsorshipBrazilian Ministry of Health/PanAmerican Health Organization [Grant Carta Acordo OPAS] [BR/LOA/1300018.001]
dc.identifier.citationVACCINE, v.34, n.13, p.1531-1539, 2016
dc.identifier.doi10.1016/j.vaccine.2016.02.026
dc.identifier.eissn1873-2518
dc.identifier.issn0264-410X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/14253
dc.language.isoeng
dc.publisherELSEVIER SCI LTD
dc.relation.ispartofVaccine
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCI LTD
dc.subjectCost-benefit analysis
dc.subjectCost-effectiveness analysis
dc.subjectMaternal immunization
dc.subjectPertussis vaccine
dc.subjectPertussis
dc.subjectWhooping cough
dc.subjectPregnancy
dc.subject.otherpregnant-women
dc.subject.othereconomic-evaluation
dc.subject.otherantibody-responses
dc.subject.otherbirth outcomes
dc.subject.otherstrategies
dc.subject.otherinfants
dc.subject.otherassociation
dc.subject.otherprograms
dc.subject.otherevents
dc.subject.othersafety
dc.subject.wosImmunology
dc.subject.wosMedicine, Research & Experimental
dc.titleCost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus20
hcfmusp.contributor.author-fmusphcANA MARLI CHRISTOVAM SARTORI
hcfmusp.contributor.author-fmusphcPATRICIA COELHO DE SOAREZ
hcfmusp.contributor.author-fmusphcEDER GATTI FERNANDES
hcfmusp.contributor.author-fmusphcLIGIA CASTELLON FIGUEIREDO GRYNINGER
hcfmusp.contributor.author-fmusphcJULIANA YUKARI KODAIRA VISCONDI
hcfmusp.contributor.author-fmusphcHILLEGONDA MARIA DUTILH NOVAES
hcfmusp.description.beginpage1531
hcfmusp.description.endpage1539
hcfmusp.description.issue13
hcfmusp.description.volume34
hcfmusp.origemWOS
hcfmusp.origem.pubmed26899375
hcfmusp.origem.scopus2-s2.0-84960434533
hcfmusp.origem.wosWOS:000372763300006
hcfmusp.publisher.cityOXFORD
hcfmusp.publisher.countryENGLAND
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