Cost-effectiveness of pertussis booster vaccination of 6-year-old children

Primary pertussis vaccination in the Russian Federation is carried out with 3 doses of the vaccine against diphtheria, whooping cough and tetanus at 3; 4.5 and 6 months. At 18 months, children are revaccinated against diphtheria, whooping cough and tetanus. At the age of 6-7 and 14 years, children are revaccinated against diphtheria and tetanus without the whooping cough component. Observational studies have shown that the clinical effectiveness of vaccination against whooping cough significantly decreases over time.

The aim of the work is to assess the cost-effectiveness of revaccination of 6-year-old children against whooping cough infection.

Material and methods. A modeling study of the cost-effectiveness of revaccination of 6-year-old children against whooping cough using an acellular vaccine was carried out from the societal perspective (direct medical and indirect costs were estimated) taking into account the herd effect of vaccination. The incidence of whooping cough and mortality associated with it corresponded to the official indicators of the Ministry of Health of the Russian Federation. In the base case the time horizon of the study is 12 years. The analysis of the costs of whooping cough therapy was carried out on the basis of the of the State Guarantees Program for the Free Provision of Medical Care to Citizens for 2024 and for the planning period of 2025 and 2026. Vaccination costs were calculated taking into account the weighted average price of the vaccine during government procurement in July-August 2024. Indirect costs were estimated based on gross domestic product (GDP) loss due to temporary disability of patients’ parents and death of patients. Costs and quality-adjusted life expectancy were discounted by 3% per year.

Results. The incremental cost-effectiveness ratio (ICER) of revaccination of children aged 6 years against whooping cough is 205.110 thousand rubles / QALY. The volume of averted costs is 2.642 thousand rubles per vaccinated child, including 0.416 thousand rubles – averted direct medical costs and 2.226 thousand rubles – averted indirect costs.

Conclusion. Taking into account the accepted assumptions, а booster dose of pertussis vaccine to 6-year-old children can be considered as a highly cost-effective intervention.

1. Alghounaim M, Alsaffar Z, Alfraij A, Bin-Hasan S, Hussain E. Whole-Cell and Acellular Pertussis Vaccine: Reflections on Efficacy // Med Princ Pract.- 2022.- Vol. 31(4).- P. 313-321. doi: 10.1159/000525468. Epub 2022 Jun 13. PMID: 35696990; PMCID: PMC9485965.

2. Harit S.M., Iozefovich O.V., Fridman I.V., Nacharova E.P., Tihomirova K.K. Vakcinoprofilaktika kokljusha: problemy, vozmozhnye reshenija // Zhurnal infektologii.- 2020.- T. 12.- № 2.- S. 50-57.

3. Langsam D, Kahana D, Shmueli E, Yamin D. Cost-Effectiveness of Pertussis Vaccination Schedule in Israel. // Vaccines (Basel).- 2021.- № 9(6).- P.590. doi: 10.3390/vaccines9060590. PMID: 34199574; PMCID: PMC8228944.

4. Tanaka M, Okubo R, Hoshi SL, Ishikawa N, Kondo M. Cost-effectiveness of pertussis booster vaccination for preschool children in Japan. // Vaccine.- 2022.- №40(7).- R.1010-1018. doi: 10.1016/j.vaccine.2022.01.001. Epub 2022 Jan 14. PMID: 35039195.

5. Ren J, Huang Z, Tian J, Li Z, Shen S, Yan H, Wang N, Hu J, Ma X, Ma Z, Liu J, Lu Y, Sun X. Evaluation of pre-school pertussis booster vaccination in Shanghai, China: A cost-effectiveness analysis // Vaccine.- 2024.- Vol. 42(21).- P. 126162. doi: 10.1016/j.vaccine.2024.126162. Epub 2024 Jul 27. PMID: 39069462.

6. Svedenija ob infekcionnyh i parazitarnyh zabolevanijah (forma N 2), 2023 g.

7. Rane MS, Halloran ME. Estimating Population-Level Effects of the Acellular Pertussis Vaccine Using Routinely Collected Immunization Data // Clin Infect Dis.- 2021.- Vol. 73(11).- P. 2101-2107. doi: 10.1093/cid/ciab333. PMID: 33881527; PMCID: PMC8826262.

8. Cho BH, Acosta AM, Leidner AJ, Faulkner AE, Zhou F. Tetanus, diphtheria and acellular pertussis (Tdap) vaccine for prevention of pertussis among adults aged 19 years and older in the United States: A cost-effectiveness analysis // Prev Med.- 2020.- Vol. 134:106066. doi: 10.1016/j.ypmed.2020.106066. Epub 2020 Mar 19. PMID: 32199910; PMCID: PMC7378888.

9. Omel’janovskij V.V., Avksent’eva M.V., Sura M.V., Ivahnenko O.I. Metodicheskie rekomendacii po raschetu zatrat pri provedenii kliniko-jekonomicheskih issledovanij lekarstvennyh preparatov. Moskva.- FGBU «CJeKKMP» Minzdrava Rossii.- 2017.- 24 s.

10. Prikaz Minzdrava Rossii ot 23.11.2021 N 1089n (red. ot 13.12.2022) “Ob utverzhdenii Uslovij i porjadka formirovanija listkov netrudosposobnosti v forme jelektronnogo dokumenta i vydachi listkov netrudosposobnosti v forme dokumenta na bumazhnom nositele v sluchajah, ustanovlennyh zakonodatel’stvom Rossijskoj Federacii” (Zaregistrirovano v Minjuste Rossii 29.11.2021 N 66067)

11. Macroeconomics and health: Investing in health for economic development. Report of the commission on macroeconomics and health to the WHO [Internet]. Geneva; 2001. Available from: http://apps.who.int/iris/bitstream/10665/42435/1/924154550X.pdf

12. Iino H, Hashiguchi M, Hori S. Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review // PLoS One.- 2022.- Vol. 17.- №4.- P. e0266934. doi: 10.1371/journal.pone.0266934. PMID: 35421181; PMCID: PMC9009631.

13. Yanovskiy M, Levy ON, Shaki YY, Zigdon A, Socol Y. Cost-Effectiveness Threshold for Healthcare: Justification and Quantification // Inquiry.- 2022.- Vol. 59:469580221081438. doi: 10.1177/00469580221081438. PMID: 35549935; PMCID: PMC9109272.

14. Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kal Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt //J Egypt Public Health Assoc.- 2024.- Vol. 99.- №1.- P.12. doi: 10.1186/s42506-024-00159-7. PMID: 38825614; PMCID: PMC11144683.

15. Briko N. I., Mindlina A. Ja., Miheeva I. V. i dr. Modelirovanie potencial’nogo jeffekta revakcinacii protiv kokljusha detej v 6–7 i 14 let v ramkah nacional’nogo kalendarja profilakticheskih privivok // Jepidemiologija i Vakcinoprofilaktika.- 2021.- Vol. 20.- №5.- P. 4–20. https://doi:10.31631/2073-3046-2021-20-5-4-20.

16. Svetlichnaja S. V., Mazankova L. N., Popovich L. D., Elagina L. A. Jekonomicheskaja ocenka vakcinacii detej ot kokljushnoj infekcii v gorode Moskva // Real’naja klinicheskaja praktika: dannye i dokazatel’stva.- 2023.- Vol. 3.- №3.- P. 8–19. https://doi.org/10.37489/2782-3784-myr-wd-37

17. Svetlichnaja S. V., Elagina L. A., Popovich L. D. Ocenka jekonomicheskoj jeffektivnosti vakcinacii protiv kokljusha na osnove dannyh real’noj klinicheskoj praktiki // Real’naja klinicheskaja praktika: dannye i dokazatel’stva.- 2023.- Vol. 3.- №1.- P. 9 — 19. https://doi.org/10.37489/2782-3784-myrwd-27.

18. Moskva, 19 avgusta 2024 g. /TASS/ Press-sluzhba Rospotrebnadzora. V RF za 2024 god vakcinirovali ot kokljusha bolee 1,5 mln chelovek. https://tass.ru/obschestvo/21634645

19. Latasa P, Garcia-Comas L, de Miguel AG, Barranco MD, Rodero I, Sanz JC, et al. Effectiveness of acellular pertussis vaccine and evolution of pertussis incidence in the community of Madrid from 1998 to 2015 //Vaccine.- 2018.- Vol.36.- №12.- P.1643–9.

20. Tubiana S, Belchior E, Guillot S, Guiso N, Levy-Bruhl D, Renacoq P. Monitoring the impact of vaccination on pertussis in infants using an active hospital-based pediatric surveillance network results from 17 years’ experience, 1996–2012, France // Pediatr Infect Dis J.- 2015.- Vol.34.- №8.- P. 814–20.

21. Hviid A, Stellfeld M, Wohlfahrt J, Andersen PH, Melbye M. The impact of pre-school booster vaccination of 4-6-year-old children on pertussis in 0-1-year-old children // Vaccine.- 2006.- Vol. 24.- №9.- P.1401–7.

22. Seppala E, Kristoffersen AB, Boas H, Vestrheim DF, Greve-Isdahl M, De Blasio BF, et al. Pertussis epidemiology including direct and indirect effects of the childhood pertussis booster vaccinations, Norway, 1998–2019 // Vaccine.- 2022.- Vol.40 (23).- P. 3142–9.

23. Lavine JS, Bjornstad ON, de Blasio BF, Storsaeter J. Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine // Vaccine.- 2012; Vol. 30.- №3.- P. 544–51.