Skip to main content

Advertisement

SpringerLink
Log in

Economic evaluation of pertussis prevention by whole-cell and acellular vaccine in Germany

  • Infectious Disease
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Acellular pertussis vaccines are less reactogenic than whole cell pertussis vaccines, but they are also more expensive. Based on simulation models, we compared the costs and effects of three alternative pertussis vaccination strategies in German children to “no prevention”: (1) vaccination with whole-cell vaccine at 45% coverage (vaccine efficacy 90%), (2) vaccination with acellular vaccine at 45% coverage (vaccine efficacy 85%), and (3) vaccination with acellular vaccine at 90% coverage. In the two low coverage scenarios expected annual savings in direct medical costs through prevention of disease were larger for whole-cell than for acellular vaccination (252 vs 216 million DM, respectively). Direct costs for treating the more important adverse events induced by whole-cell vaccination (16.9 million DM annually) did not outweigh the higher direct costs of pertussis infections not prevented with the acellular vaccine and the higher price of the acellular vaccine. However, vaccination with acellular pertussis vaccine rapidly becomes as cost saving as vaccination with whole-cell vaccine as soon as vaccination coverage can be raised from 45% to 52.5% with acellular vaccine. Acellular vaccination is also the superior alternative when considering indirect cost savings resulting from reduction in work-loss due to adverse events.

Conclusion

In our simulations, the most cost-effective pertussis prevention strategy was the use of an effective whole-cell vaccine with a high coverage rate. Introduction of the more expensive acellular pertussis vaccines becomes cost saving if at least a 7.5% increase in coverage is achieved. If also non-medical indirect costs to parents resulting from vaccine associated side-effects are accounted for, acellular vaccines may be more cost-effective also in countries with already high whole-cell vaccine coverage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Annunziato P, Rothstein E, Bernstein H, Pichichero M (1992) Comparison of a 3-component acellular pertussis vaccine (DTaP) with whole cell pertussis vaccine in 4–6 year old children. Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim, American Society for Microbiology, Washington, Abstract 305

  2. Aoyama T, Hagiwara S, Marase Y, Kato T, Iwata T (1986) Adverse reactions and antibody responses to acellular pertussis vaccine. J Pediatr 109:925–930

    Article  PubMed  CAS  Google Scholar 

  3. Aoyama T, Murase Y, Gonda T, Iwata T (1988) Type-specific efficacy of acellular pertussis vaccine. Am J Dis Child 142:40–42

    PubMed  CAS  Google Scholar 

  4. Barkin RM, Pichichero ME (1979) Diphtheria-Pertussis-tetanus Vaccine: Reactogenicity of Commercial Products. Pediatrics 63:256–261

    PubMed  CAS  Google Scholar 

  5. Bijkerk H (1986) Het nut van immunisatie tegen kinkhoest. Ned Tijdschr Geneeskd 130:41–42

    PubMed  CAS  Google Scholar 

  6. Binkin NJ, Salmaso S, Tozzi AE, Scuderi G, Greco D (1992) Epidemiology of pertussis in a developed country with low vaccination coverage: the Italian experience. Pediatr Infect Dis J 11:653–661

    PubMed  CAS  Google Scholar 

  7. Blackwelder WC, Storsaeter J, Cherry JD, Olin P, Hallander HO (1991) Acellular pertussis vaccines. Efficacy and evaluation of clinical case definitions Am J Dis Child 145:1285–1289

    PubMed  CAS  Google Scholar 

  8. Blumberg DA, Mink CM, Cherry JD, Johnson C, Garber R, Plotkin S, Watson B, Ballanco GA, Daum RS, Sullivan B, Townsend TR, Brayton J, Gooch WM, Belson DB, Congeni BL, Prober CG, Hackell JG, Dekker CL, Christenson PD, and the APDT Study Group (1991) Comparison of acellular and whole-cell pertussis-omponent diphtheria-tetanus-pertussis vaccines in infants. J Pediatr 119:194–204

    Article  PubMed  CAS  Google Scholar 

  9. BrownF, Greco D, Mastrantonio P, Salmaso S, Wassilak S (1997) Pertussis vaccine trials. Dev Biol Stand 89

  10. Cherry JD, Brunell PA, Golden GS, Karzon DT (1988) Report of the Task Force on Pertussis and Pertussis Immunization-1988. Pediatrics 81[Supple]:939–984

    Google Scholar 

  11. Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CR (1981) Nature and rates of adverse reactions associated with DTP and DT Immunizations in infants and children. Pediatrics 68:650–660

    PubMed  CAS  Google Scholar 

  12. Dittmann S, Rasch D (1990) Ausgewählte infektiöse und parasitäre Krankheiten. In: Institut für Medizinische Statistik und Datenverarbeitung: Das Gesundheitswesen — Jahresgesundheitsbericht 1989 für das Gebiet der ehemaligen DDR. Ärztebuch Verlag, Berlin, pp 91–96

    Google Scholar 

  13. Edwards KM, Karzon DT, Biber M (1990) Pertussis vaccines. Pediatr Clin North Am: 549–566

  14. Englund JA, Edwards K, Decker M, Anderson E, Pichichero M, Steinhoff M (1991) Multicenter study of acellular (AC) and whole-cell (WC) pertussis vaccines in young children. Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, American Society for Microbiology, Washington, Abstract 62

  15. Feldman S, Perry CS, Andrew M, Jones L, Moffitt JE, (1992) Comparison of acellular (B type) and whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines as the first booster immunization in 15-to 24-month-old children. J Pediatr 121:857–861

    Article  PubMed  CAS  Google Scholar 

  16. Finger H, Wirsing von Köning CH, Tacken A, Wassilak SGF (1991) The epidemiological situation of pertussis in the Federal Republic of Germany. Dev Biol Stand 73:343–355

    PubMed  CAS  Google Scholar 

  17. Finger H, Wirsing von Köning CH (1992) Epidemiologie des Keuchhustens. Gesundheitswesen 54:541–545

    PubMed  CAS  Google Scholar 

  18. Fulginiti VA, Henderson RH (1992) How safe are pertussis and rubella vaccines? A commentary on the Institute of Medicine Report. Pediatrics 89:334–336

    PubMed  CAS  Google Scholar 

  19. Glode M, Joffe L, Reisinger K, Blatter M, Plotkin S, Watson B, Grossmann L, Asmar B, Berry M, Starobin S, Fisch G, Hackell JG, Sheip B, Mckee B (1992) Safety and immunogenicity of acellular pertussis vaccine combined with diphtheria and tetanus toxoids in 17 to 24 month old children. Pediatr Infect Dis J 11:530–535

    PubMed  CAS  Google Scholar 

  20. Greco D, Salmaso S, Mastrantonio P, Giuliano M, Tozzi AE, Anemona A, Ciofi degli Atti ML, Giammanco A, Panei P, Blackwelder WC, Klein DL, Wassilak S, and the Progetto Pertosse Working Group (1996) A controlled trial of two acellular vaccines and one whole-cell vaccine against pertussis. N Engl J Med 334:341–348

    Article  PubMed  CAS  Google Scholar 

  21. Gustafsson L, Hallander HO, Olin P, Reizenstein E, Storsaeter J (1996) A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine. N Engl J Med 334:349–55

    Article  PubMed  CAS  Google Scholar 

  22. Heininger U, Cherry JD (1993) Clinical and laboratory diagnosis of pertussis in the regions of a large vaccine efficacy trial in Germany. Pediatr Infect Dis J 12:504–509

    PubMed  CAS  Google Scholar 

  23. Hinman AR, Koplan JP (1984) Pertussis and pertussis vaccine. Reanalysis of benefits, risks and costs. JAMA 251:3109–3113

    Article  PubMed  CAS  Google Scholar 

  24. Hinman AR, Koplan JP (1985) Pertussis and pertussis vaccine: Further analysis of benefits, risks and costs. Dev Biol Stand 61:429–437

    PubMed  CAS  Google Scholar 

  25. Isomura S (1988) Efficacy and safety of acellular pertussis vaccine in Aichi Prefecture, Japan. Pediatr infect Dis J 7:258–262

    Article  PubMed  CAS  Google Scholar 

  26. Just M, Kanra G, Bogaerts H, Berger R, Ceyhan M, Petre J (1991) Two trials of an acellular DTP vaccine in comparison with a whole-cell DTP vaccine in Infants: evaluation of two PT doses and two vaccination schedules. Dev Biol Stand 73:275–283

    PubMed  CAS  Google Scholar 

  27. Kamiya H, Ritsue N, Matsuda T, Yasuda N, Christenson PD, Cherry JD (1992) Immunogenicity and reactogenicity of Takeda acellular pertussis-component diphtheria-tetanus-pertussis vaccine in 2 and 3 month old children in Japan. Am J Dis Child 146:1141–1147

    PubMed  CAS  Google Scholar 

  28. KanraG, Ruuskanen O, Ceyhan M, Mertsola J, Vandepapelier P, Melot V, Bogaerts H (1991) 69 kDa in acellular DTP vaccine: Safety in adults and booster in 18 month old children. Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, American Society for Microbiology, Washington, Abstract 61

  29. Koplan JP, Schoenbaum SC, Weinstein MC, Fraser DW (1979) Pertussis vaccine — an analysis of benefits, risks and costs. N Engl J Med 301:906–911

    Article  PubMed  CAS  Google Scholar 

  30. Kulenkampf M, Schwartzman JS, Wilson J (1974) Neurological complications of pertussis inoculation. Arch Dis Child 49:46–49

    Article  Google Scholar 

  31. Long SS, Deforest A (1990). Longitudinal study of adverse reactions following diphtheria-tetanus-pertussis vaccine in infancy. Pediatrics 85:294–302

    PubMed  CAS  Google Scholar 

  32. Mortimer EA, Kimura M, Schijf-Evers D (1990) Protective efficacy of the Takeda acellular pertussis vaccine combined with diphtheria and tetanus toxoids following household exposure of Japanese children. Am J Dis Child 144:899–904

    PubMed  Google Scholar 

  33. Olin P (1997) Commentary: the best acellular pertussis vaccines are multicomponent. Pediatr Infect Dis J 16:517 119

    Article  Google Scholar 

  34. Pichichero ME, Francis AB, Blatter MM, Reisinger KS, Green JL, Marsocci SM, Disney FA (1992) Acellular pertussis vaccination of 2 month old infants in the United States. Pediatrics 89:882–887

    PubMed  CAS  Google Scholar 

  35. Plotkin SA, Cadoz M (1997) The acellular pertussis vaccine trials: an interpretation. Pediatr Infect Dis J 16:508–517

    Article  PubMed  CAS  Google Scholar 

  36. Podda A, Carapella De Luca E (1992) Acellular pertussis vaccine composed of genetically inactivated pertussis toxin: safety and immunogenicity in 12 to 24 and 2 to 4 month old children. J Pediatr 120:680–685

    Article  PubMed  CAS  Google Scholar 

  37. Romanus V, Jonsell R, Pichichero M (1987) Pertussis in Sweden after the cessation of general immunization in 1979. Pediatr Infect Dis J 6:364–371

    PubMed  CAS  Google Scholar 

  38. Schmitt HJ, Müschenborn M, Wagner S, Knuf M, Bock HL, Bogaerts H, Clemens R (1996) Immunogenicity and reactogenicity of a bicomponent and a tricomponent acellular pertussis-diphtheria-tetanus (DTaP) vaccine in primary immunization and as second year booster: a double-blind randomized trial. Int J Inf Dis 1:6–13

    Article  Google Scholar 

  39. Schmitt HJ, Wirsing von König CH, Neiss A, Bogaerts H, Bock HL, Schulte-Wissermann H, Gahr M, Schult R, Folkens JU Rauh W, Clemens R (1996) Efficacy of acellular pertussis vaccine in early childhood after houselhod exposure. JAMA 275:37–41

    Article  PubMed  CAS  Google Scholar 

  40. Schmitt HJ, Wirsing von König CH (1997) Pertussis Vaccines 1997. Bailliérs Clinical Paediatrics 5:121–138

    Google Scholar 

  41. Schmitz M, Wassilak S, Schulte-Wisserman H, Wirsing von König CH (1983) Schätzungen zur Pertussis-Inzidenz am linken Niederrhein. Monatsschr Kinderheilkd 142:41–44

    Google Scholar 

  42. Takayama N, Watanabe H, Fujita I, Minamitani M (1989) Seroepidemiology of pertussis in the Japanese population. Med Microbiol Immunol 178:1–8

    PubMed  CAS  Google Scholar 

  43. WHO (1996) The World Health Report 1996. WHO, Geneva, 1996

    Google Scholar 

  44. World Health Organization (1995). Expanded programme on Immunization — Summary for the WHO European Region. WHO/EPI/CEIS/95.2 EU

Download references

Author information

Authors and Affiliations

  1. Institute for Medical Technology Assessment, Erasmus University, P.O. 1738, NL-3000, DR Rotterdam, The Netherlands

    G. Tormans & E. Van Doorslaer

  2. Department of Epidemiology and Community Medicine, University of Antwerp, Belgium

    G. Tormans, E. Van Doorslaer, P. van Damme & R. Clara

  3. Pädiatrische Infektiologie, Klinik für Allgemeine Pädiatrie, Christian-Albrechts-Universität zu Kiel, Germany

    H. J. Schmitt

Authors
  1. G. Tormans
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Van Doorslaer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. van Damme
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Clara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. J. Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Van Doorslaer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tormans, G., Doorslaer, E.V., Damme, P.v. et al. Economic evaluation of pertussis prevention by whole-cell and acellular vaccine in Germany. Eur J Pediatr 157, 395–401 (1998). https://doi.org/10.1007/s004310050837

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004310050837

Key words

Search

Navigation