Questions have been raised about the cost-effectiveness of the one-time tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults, but a new study recommends the continued benefit of the vaccine.

The Advisory Committee on Immunization Practices currently recommends Tdap vaccination for all adults aged 19 years and older. A study in Preventive Medicine sought to evaluate the cost-effectiveness of Tdap vaccination for Tdap-eligible adults aged 19 through 85 years in the United States.

CDC researchers developed a cost-effectiveness model to compute costs and health outcomes associated with pertussis among 100,000 Tdap-eligible persons of each age cohort.

The researchers explain that the cost per quality-adjusted life-year (QALY) saved was evaluated for the vaccination scenarios. They also used sensitivity analyses to evaluate the impacts of changes in key variables. All costs were adjusted to U.S. dollars for 2018, with an annual discount rate of 3% applied to costs and outcomes.

Results indicate that the incremental cost-effectiveness ratios (ICERs) for vaccinating U.S. adults aged 19 to 85 years with Tdap ranged from $248,000/QALY to $900,000/QALY. The authors point out that the lowest cost per QALY was $248,000 for the age-65-year cohort, followed by $332,000 for the age-19-year cohort and $477,000 for the age-50-year cohort.

They authors advise that sensitivity analysis showed that the most dramatic changes in ICER occurred when the underreporting factor, vaccine effectiveness, and vaccination costs were changed.

“While Tdap vaccination may not be as cost effective as predicted earlier, it remains the best available preventive measure against pertussis,” the authors conclude. “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.”

Based on the 2016 National Health Interview Survey, vaccination of adults aged 19 years and older with Tdap increased by 3.4 percentage points to 26.6% overall.
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