Cost of Bordetella pertussis illness in tertiary hospitals in Argentina

Abstract

The National Immunization Commission and the National Program for the Control of Vaccine-Preventable Diseases (Programa Nacional de Control de Enfermedades Inmunoprevenibles, ProNaCEI) updated the immunization policy in relation to Bordetella pertussis (BP) in 2009 in order to improve the control of this disease in accordance with international recommendations. To evaluate the financial impact of this new immunization policy, we must first know the cost on the health system of having a hospitalized or outpatient child infected with BP. The objective of this study was to describe the profile of costs of hospitalized or outpatient children with laboratory-confirmed BP infection in three hospitals of Argentina. This was a prospective study of the cost of BP in the period between December 2010 and March 2012. Results. The total cost for the entire cohort was 1 170 663.32 ARS (236 497.64 USD); direct medical costs were 1 124 052.31 ARS (227 081.27 USD); indirect costs and out-of-pocket expenses were 46 611 ARS (9416.6 USD). From this data, it is possible to conclude that the total average cost per patient was 10 546.52 ARS (95% CI: 9009-13 840) (2130.60 USD, 95% CI: 1820-2795), the direct medical cost per patient was 10 126.6 ARS (95% CI: 8607-13 171) (2045.77 USD, 95% CI: 1738-2660), and the indirect plus out-of-pocket costs (transportation and extras) were 419.92 ARS (95% CI: 344.7-565.3) (84 USD, 95% CI: 69-115). Conclusion. The cost of a hospitalized child with confirmed BP is 10 546.52 ARS (95% CI: 9009-13 840) (2130.60 USD, 95% CI: 1820-2795). Direct non-medical costs and overhead costs account for 4% of the total cost, amounting to 419.91 ARS per family (84 USD, 95% CI: 69-115), approximately an 8% of an average salary.

Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative

“…A further study from the US did not reach a definite conclusion whether vaccination early in the third trimester (27-31 WG) was associated with higher protection than vaccination later in the third trimester (32)(33)(34)(35)(36), likely due to the small number of cases [28]. A study from Spain reported that the VE of vaccination against pertussis in pregnancy was 88% (95% CI = 53.8%-96.5%) in the prevention of laboratory-confirmed pertussis in infants <2 months of age, and the VE was not different in infants of mothers vaccinated during 26-31 WG compared with ≥32 WG [58].…”

“…Studies have attempted to address the effect of timing of vaccination against pertussis in pregnancy on VE and results have been inconclusive. Observational studies from the US showed that vaccination in the third trimester (27)(28)(29)(30)(31)(32)(33)(34)(35)(36) weeks' gestation (WG), the vaccination timeframe recommended by the US Centers for Disease Control and prevention) was more protective in the prevention of laboratory-confirmed pertussis in infants <8 and <12 weeks old and born at term when compared with vaccination outside 27-36 WG [28]. In addition, a study from the US reported that infants <18 months of age whose mothers received the pertussis vaccine <27 WG did not have reductions in pertussis rates compared with infants of unvaccinated mothers, although this study is limited by the small number of cases leading to a wide confidence interval (CI) (hazard ratio (HR) for pertussis = 1.10, 95% CI = 0.54-2.25) [57].…”

“…One study from Switzerland showed that cord anti-PT and anti-FHA IgG concentrations were higher in women vaccinated between 13-25 WG compared with those vaccinated after 25 WG gestation in both term [66] and preterm infants [67]. Another study from Argentina did not find significant differences between cord anti-PT IgG concentrations following second (13-26 WG) vs. third (27)(28)(29)(30)(31)(32)(33)(34)(35)(36) trimester vaccination [68]. However, the number of subjects in the latter study was rather small, leading to very broad confidence intervals (CI) of antibody levels indicating that the study was underpowered to demonstrate the effect of timing of vaccination in pregnancy.…”

“…Vaccination against pertussis in pregnancy was also shown to be protective in studies from middle-income countries [31]. In Brazil, this strategy was 82% protective in the prevention of laboratory-confirmed pertussis infection in infants <2 months of age [23], and prevention of all pertussis infant deaths in Argentina in the year following introduction of pertussis vaccination in pregnancy was achieved [32].…”