What pertussis mortality rates make maternal acellular pertussis immunization cost-effective in low- and middle-income countries? A decision analysis
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2016
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Background. Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis con tinues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent
many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of
public health resources in LMICs.
Methods. We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant
vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices,
one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective
by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates.
Results. Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by
current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report.
For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018
per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant
pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY.
Conclusions. For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many
LMICs only if the vaccine were offered at less than $1–$2/dose.
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Pertussis, Maternal immunization, Mortality, Cost-effectiveness, Decision analysis
Citação
RUSSELL, Louise B. et al. What pertussis mortality rates make maternal acellular pertussis immunization cost-effective in low- and middle-income countries? A decision analysis. Clinical Infectious Diseases, Oxford, v. 63, p. S227-S235, 2016. Suppl. 4. DOI: 10.1093/cid/ciw558. Disponível em: https://academic.oup.com/cid/article/63/suppl_4/S227/2526421?login=true. Acesso em: 4 dez. 2024.