Sartori Ana Marli Christovam, de Soárez Patrícia Coelho, Fernandes Eder Gatti, Gryninger Ligia Castellon Figueiredo, Viscondi Juliana Yukari Kodaira, Novaes Hillegonda Maria Dutilh
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, ICHC, 4° andar, sala 4028 Cerqueira César, 05403-000 São Paulo, SP, Brazil.
Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 2° andar, sala 2228, CEP: 01246-903, São Paulo, SP, Brazil.
Vaccine. 2016 Mar 18;34(13):1531-1539. doi: 10.1016/j.vaccine.2016.02.026. Epub 2016 Feb 17.
Pertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil.
Economic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed.
Maternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness.
The results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
自2011年以来，巴西百日咳发病率显著上升，尽管儿童期全细胞百日咳疫苗接种覆盖率很高。4个月以下婴儿受影响最大。本研究旨在评估在巴西国家免疫规划中引入破伤风-白喉-无细胞百日咳疫苗（Tdap）普遍孕产妇接种的成本效益。
使用决策树模型进行经济评估，比较两种策略：（1）在妊娠晚期对孕妇进行一剂Tdap普遍接种，（2）现行做法（不对孕妇进行百日咳疫苗接种），从卫生系统和社会的角度进行评估。对代表接种疫苗孕妇数量的年度新生儿队列进行为期一年的跟踪。疫苗效力基于文献综述。流行病学、医疗资源利用和成本估计基于从巴西卫生信息系统获取的当地数据。病例接触者的流行病学调查和治疗成本纳入分析。由于时间范围为一年，成本和效益未应用贴现率。主要结果是每挽救一个生命年（LYS）的成本。进行了单变量以及最佳和最坏情况的敏感性分析。
对一个年度队列的孕妇进行疫苗接种，疫苗效力为78%，每剂疫苗成本为12.39美元，从卫生系统和社会角度来看，将避免661例百日咳病例和24例婴儿死亡，挽救1800个生命年，成本分别为28942808美元和29002947美元。普遍免疫从卫生系统和社会角度来看，每LYS的增量成本效果比分别为15608美元和15590美元。在敏感性分析中，增量成本效果比对挽救生命年的贴现、病死率变化、疾病发病率、疫苗成本和疫苗效力最为敏感。
结果表明，在巴西，对孕妇普遍接种Tdap疫苗是预防婴儿百日咳病例和死亡的一种具有成本效益的干预措施。
