Is adding maternal vaccination to prevent whooping cough cost-effective in Australia?

Abstract

Pertussis or whooping cough, a highly infectious respiratory infection, causes significant morbidity and mortality in infants. In adolescents and adults, pertussis presents with atypical symptoms often resulting in under-diagnosis and under-reporting, increasing the risk of transmission to more vulnerable groups. Maternal vaccination against pertussis protects mothers and newborns. This evaluation assessed the cost-effectiveness of adding maternal dTpa (reduced antigen diphtheria, Tetanus, acellular pertussis) vaccination to the 2016 nationally-funded pertussis program (DTPa [Diphtheria, Tetanus, acellular Pertussis] at 2, 4, 6, 18 months, 4 years and dTpa at 12–13 years) in Australia.A static cross-sectional population model was developed using a one-year period at steady-state. The model considered the total Australian population, stratified by age. Vaccine effectiveness against pertussis infection was assumed to be 92% in mothers and 91% in newborns, based on observational and case-control studies. The model included conservative assumptions around unreported cases.With 70% coverage, adding maternal vaccination to the existing pertussis program would prevent 8,847 pertussis cases, 422 outpatient cases, 146 hospitalizations and 0.54 deaths per year at the population level. With a 5% discount rate, 138.5 quality-adjusted life-years (QALYs) would be gained at an extra cost of AUS$ 4.44 million and an incremental cost-effectiveness ratio of AUS$ 32,065 per QALY gained. Sensitivity and scenario analyses demonstrated that outcomes were most sensitive to assumptions around vaccine effectiveness, duration of protection in mothers, and disutility of unreported cases.In conclusion, dTpa vaccination in the third trimester of pregnancy is likely to be cost-effective from a healthcare payer perspective in Australia.

Modeling the cost-effectiveness of maternal acellular pertussis immunization (aP) in different socioeconomic settings: A dynamic transmission model of pertussis in three Brazilian states

“…An analysis from the United States found that differences in the reporting probability (or reporting rate as it is usually denominated) implied a change in the decision whether or not to adopt maternal vaccination [8] . In a study from Australia, the reporting rate was the second most important parameter influencing the cost-effectiveness of maternal immunization [47] . When authors assumed that a higher fraction of cases was reported, maternal aP was more cost-effective.…”

Atangana-Baleanu Fractional Dynamics of Predictive Whooping Cough Model with Optimal Control Analysis

“…This section is devoted to a comprehensive theoretical analysis of the proposed fractional model (6) where we investigate some key characteristics of the model and show that the model is well-posed for numerical approximations.…”

“…Let V (t) satisfy Equation (6). We apply the Atangana-Beleanu fractional integral (4) to both sides of (6) to obtain…”

“…In [5], an effective numerical scheme was presented to simulate a second-order whooping cough model. In 2018, researchers conducted a study on the cost-effectiveness of maternal vaccination for whooping cough in Australia [6]. A whooping cough model with optimal vaccination control was studied in [7].…”

Maternal immunization: trends in South and Southeast Asian countries

“…In particular, more than 40 countries worldwide have recommendations for Tdap during pregnancy, including advanced countries like the United States, the United Kingdom, and Australia [11,44]. In these countries, the strategy was assessed as cost-effective [45][46][47]. However, such data are lacking for the South and Southeast Asian regions.…”