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Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures

OBJECTIVES: This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS: We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2...

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Autores principales: Botwright, Siobhan, Win, Ei Mon, Kapol, Nattiya, Benjawan, Sirikanlaya, Teerawattananon, Yot
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644008/
https://www.ncbi.nlm.nih.gov/pubmed/36348154
http://dx.doi.org/10.1007/s40273-022-01207-w
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author Botwright, Siobhan
Win, Ei Mon
Kapol, Nattiya
Benjawan, Sirikanlaya
Teerawattananon, Yot
author_facet Botwright, Siobhan
Win, Ei Mon
Kapol, Nattiya
Benjawan, Sirikanlaya
Teerawattananon, Yot
author_sort Botwright, Siobhan
collection PubMed
description OBJECTIVES: This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS: We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. RESULTS: Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. CONCLUSIONS: We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40273-022-01207-w.
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spelling pubmed-96440082022-11-14 Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures Botwright, Siobhan Win, Ei Mon Kapol, Nattiya Benjawan, Sirikanlaya Teerawattananon, Yot Pharmacoeconomics Original Research Article OBJECTIVES: This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS: We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. RESULTS: Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. CONCLUSIONS: We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40273-022-01207-w. Springer International Publishing 2022-11-09 2023 /pmc/articles/PMC9644008/ /pubmed/36348154 http://dx.doi.org/10.1007/s40273-022-01207-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Botwright, Siobhan
Win, Ei Mon
Kapol, Nattiya
Benjawan, Sirikanlaya
Teerawattananon, Yot
Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title_full Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title_fullStr Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title_full_unstemmed Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title_short Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures
title_sort cost-utility analysis of universal maternal pertussis immunisation in thailand: a comparison of two model structures
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644008/
https://www.ncbi.nlm.nih.gov/pubmed/36348154
http://dx.doi.org/10.1007/s40273-022-01207-w
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