Cost-effectiveness of next-generation vaccines: The case of pertussis

Abstract

Despite steady vaccination coverage rates, pertussis incidence in the United States has continued to rise. This public health challenge has motivated calls for the development of a new vaccine with greater efficacy and duration of protection. Any next-generation vaccine would likely come at a higher cost, and must provide sufficient health benefits beyond those provided by the current vaccine in order to be deemed cost-effective. Using an age-structured transmission model of pertussis, we quantified the health and economic benefits of a next-generation vaccine that would enhance either the efficacy or duration of protection of the childhood series, the duration of the adult booster, or a combination. We developed a metric, the maximum cost-effective price increase (MCPI), to compare the potential value of such improvements. The MCPI estimates the per-dose price increase that would maintain the cost-effectiveness of pertussis vaccination. We evaluated the MCPI across a range of potential single and combined improvements to the pertussis vaccine. As an upper bound, we found that a next-generation vaccine which could achieve perfect efficacy for the childhood series would permit an MCPI of $18 per dose (95% CI: $12-$31). Pertussis vaccine improvements that extend the duration of protection to an average of 75 years would allow for an MCPI of $22 per dose for the childhood series (CI: $10-$33) or $12 for the adult booster (CI: $4-$18). Despite the short duration of the adult booster, improvements to the childhood series could be more valuable than improvements to the adult booster. Combining improvements in both efficacy and duration, a childhood series with perfect efficacy and average duration of 75 years would permit an MCPI of $39 per dose, the highest of any scenario evaluated. Our results highlight the utility of the MCPI metric in evaluating potential vaccines or other interventions when prices are unknown.

Cost-Effectiveness of Pertussis Vaccination Schedule in Israel

“…Specifically, we stratified the population into 27 age groups: 0-2 months, 2-4 months, 4-6 months, 6-8 months, 8-10 months, 10-12 months, 1-2 years, 2-3 years [19,32], infected individuals can be either symptomatic or asymptomatic. Individuals in each age group in the model were divided into six health compartments: susceptible, symptomatic infectious, asymptomatic infectious, whole-cell vaccinated, acellular vaccinated, and recovered.…”

Modelling microbial infection to address global health challenges

“…Collaboration between modellers and disease experts is thus instrumental to ensuring the biological plausibility of these parameter distributions 90,91 . The uncertainty analysis produces both a central point estimate and a range for each outcome, a combination which can inform stakeholders about the best-case and worst-case scenarios as well as the likelihood that an intervention will be successful [92][93][94] .…”