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Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis

BACKGROUND: Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP) strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, es...

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Autores principales: Thampi, Nisha, Gurol-Urganci, Ipek, Crowcroft, Natasha S., Sander, Beate
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352053/
https://www.ncbi.nlm.nih.gov/pubmed/25747269
http://dx.doi.org/10.1371/journal.pone.0119271
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author Thampi, Nisha
Gurol-Urganci, Ipek
Crowcroft, Natasha S.
Sander, Beate
author_facet Thampi, Nisha
Gurol-Urganci, Ipek
Crowcroft, Natasha S.
Sander, Beate
author_sort Thampi, Nisha
collection PubMed
description BACKGROUND: Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP) strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, especially with erythromycin among infants who have the highest disease burden. Newer macrolides offer fewer side effects at higher drug costs. We sought to determine the cost-effectiveness of PEP strategies from the health care payer perspective. METHODS: A Markov model was constructed to examine 4 mutually exclusive strategies: erythromycin, azithromycin, clarithromycin, or no intervention, stratified by age group of contacts (“infant”, “child”, and “adult”). Transition probabilities, costs and quality-adjusted life years (QALYs) were derived from the literature. Chronic neurologic sequelae were modeled over a lifetime, with costs and QALYs discounted at 5%. Associated health outcomes and costs were compared, and incremental cost-effectiveness ratios (ICER) were calculated in 2012 Canadian dollars. Deterministic and probabilistic sensitivity analyses were performed to evaluate the degree of uncertainty in the results. FINDINGS: Azithromycin offered the highest QALYs in all scenarios. While this was the dominant strategy among infants, it produced an ICER of $16,963 per QALY among children and $2,415 per QALY among adults. Total QALYs with azithromycin were 19.7 for a 5-kg infant, 19.4 for a 10-year-old child, and 18.8 for a 30-year-old adult. The costs of azithromycin PEP among infants, children and adults were $1,976, $132 and $90, respectively. While results were sensitive to changes in PEP effectiveness (11% to 87%), disease transmission (variable among age groups) and hospitalization costs ($379 to $59,644), the choice of strategy remained unchanged. INTERPRETATION: Pertussis PEP is a cost-effective strategy compared with no intervention and plays an important role in contact management, potentially in outbreak situations. From a healthcare payer perspective, azithromycin is the optimal strategy among all contact groups.
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spelling pubmed-43520532015-03-17 Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis Thampi, Nisha Gurol-Urganci, Ipek Crowcroft, Natasha S. Sander, Beate PLoS One Research Article BACKGROUND: Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP) strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, especially with erythromycin among infants who have the highest disease burden. Newer macrolides offer fewer side effects at higher drug costs. We sought to determine the cost-effectiveness of PEP strategies from the health care payer perspective. METHODS: A Markov model was constructed to examine 4 mutually exclusive strategies: erythromycin, azithromycin, clarithromycin, or no intervention, stratified by age group of contacts (“infant”, “child”, and “adult”). Transition probabilities, costs and quality-adjusted life years (QALYs) were derived from the literature. Chronic neurologic sequelae were modeled over a lifetime, with costs and QALYs discounted at 5%. Associated health outcomes and costs were compared, and incremental cost-effectiveness ratios (ICER) were calculated in 2012 Canadian dollars. Deterministic and probabilistic sensitivity analyses were performed to evaluate the degree of uncertainty in the results. FINDINGS: Azithromycin offered the highest QALYs in all scenarios. While this was the dominant strategy among infants, it produced an ICER of $16,963 per QALY among children and $2,415 per QALY among adults. Total QALYs with azithromycin were 19.7 for a 5-kg infant, 19.4 for a 10-year-old child, and 18.8 for a 30-year-old adult. The costs of azithromycin PEP among infants, children and adults were $1,976, $132 and $90, respectively. While results were sensitive to changes in PEP effectiveness (11% to 87%), disease transmission (variable among age groups) and hospitalization costs ($379 to $59,644), the choice of strategy remained unchanged. INTERPRETATION: Pertussis PEP is a cost-effective strategy compared with no intervention and plays an important role in contact management, potentially in outbreak situations. From a healthcare payer perspective, azithromycin is the optimal strategy among all contact groups. Public Library of Science 2015-03-06 /pmc/articles/PMC4352053/ /pubmed/25747269 http://dx.doi.org/10.1371/journal.pone.0119271 Text en © 2015 Thampi et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Thampi, Nisha
Gurol-Urganci, Ipek
Crowcroft, Natasha S.
Sander, Beate
Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title_full Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title_fullStr Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title_full_unstemmed Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title_short Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
title_sort pertussis post-exposure prophylaxis among household contacts: a cost-utility analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352053/
https://www.ncbi.nlm.nih.gov/pubmed/25747269
http://dx.doi.org/10.1371/journal.pone.0119271
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