Abstract
Introduction: An unexpected resurgence of pertussis cases and infant deaths was observed in some countries that had switched to acellular pertussis vaccines in the primary immunisation schedule. In response to the outbreaks, maternal pertussis vaccination programmes in pregnant women have been adopted worldwide, including the USA in 2011 and the UK in 2012. Following the success of the programme in England, we evaluated the health and economic impact of stopping versus continuing the maternal pertussis immunisation to inform public health policy making.
Methods: We used a mathematical model to estimate the number of infant hospitalisations and deaths related to pertussis in England over 2019–2038. Losses in quality-adjusted life years, QALYs, were considered for infants (aged 0–2 months) who survived or died from pertussis, bereaved parents (of infants who died from pertussis), and women with pertussis (aged 20–44 years). Direct medical costs to the National Health Service included infant hospitalisations, maternal vaccinations, and disease in women. Costs and QALYs were discounted at 3.5%. Changes in the incremental cost-effectiveness ratio, ICER, were explored in sensitivity analyses.
Results: The model supports continuing the maternal pertussis immunisation programme as a cost-effective intervention at an ICER of £14,500/QALY (2.5% and 97.5%-quantile: £7,300/QALY to £32,400/QALY). Stopping versus continuing the maternal programme results in an estimated mean of 972 (range 582 to 1489) versus 308 (184 to 471) infant hospitalisations annually. Results were most sensitive to the number of hospitalisations and deaths when stopping the maternal programme. At a cost-effectiveness threshold of £30,000/QALY, the probability of the maternal programme being cost-effective was 96.2%. Conclusion: Our findings support continuing the maternal pertussis vaccination programme as otherwise higher levels of disease activity and infant mortality are expected to return. These results have led policy makers to decide to continue the maternal programme in the UK routine immunisation schedule.
| Original language | English |
|---|---|
| Pages (from-to) | 4500-4509 |
| Number of pages | 10 |
| Journal | Vaccine |
| Volume | 39 |
| Issue number | 32 |
| Early online date | 26 Jun 2021 |
| DOIs | |
| Publication status | Published - 22 Jul 2021 |
Bibliographical note
Funding Information: This work was supported by Public Health England (PHE), which is an executive agency of the Department of Health (DH). The authors had sole responsibility for the study design, data collection, data analysis, data interpretation, and writing of the report. MJ was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with PHE (Grant Reference Code HPRU-2012–10096; NIHR200929). FGS and MJ were also supported by the NIHR HPRU in Modelling and Health Economics, a partnership between PHE, Imperial College London and LSHTM (grant code NIHR200908). The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, the DH, or PHE.Open Access: Under an Open Government (OGL) license. https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/
Publisher Copyright: Crown Copyright © 2021 Published by Elsevier Ltd.
Citation: Frank Sandmann, Mark Jit, Nick Andrews, Hannah L. Buckley, Helen Campbell, Sonia Ribeiro, Bersabeh Sile, Julia Stowe, Elise Tessier, Mary Ramsay, Gayatri Amirthalingam, Yoon H. Choi,
Evaluating the impact of a continued maternal pertussis immunisation programme in England: A modelling study and cost-effectiveness analysis, Vaccine, Volume 39, Issue 32, 2021, Pages 4500-4509, ISSN 0264-410X,
DOI: https://doi.org/10.1016/j.vaccine.2021.06.042.
Keywords
- Economic evaluation
- Maternal vaccination
- Mathematical model
- Pertussis
- Public health
- Resurgence
