Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis

Dan Wu; Rize Jing; Hui Zheng; Kun He; Yixing Li; Wenzhou Yu; Zundong Yin; Hai Fang

doi:10.1016/j.jval.2022.10.011

Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis

Value Health. 2023 May;26(5):666-675. doi: 10.1016/j.jval.2022.10.011. Epub 2022 Oct 31.

Authors

Dan Wu¹, Rize Jing², Hui Zheng¹, Kun He³, Yixing Li¹, Wenzhou Yu¹, Zundong Yin⁴, Hai Fang⁵

Affiliations

¹ National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
² School of Public Administration and Policy, Renmin University of China, Beijing, China; Health Science, Hospital Reform and Medical Big Data Liberal Arts and Sciences Cross Platform, Renmin University of China, Beijing, China.
³ China Center for Health Development Studies, Peking University, Beijing, China.
⁴ National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: yinzd@chinacdc.cn.
⁵ China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China; Institute of Global Health and Development, Peking University, Beijing, China. Electronic address: hfang@hsc.pku.edu.cn.

PMID: 36328326
DOI: 10.1016/j.jval.2022.10.011

Abstract

Objectives: This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017.

Methods: We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges.

Results: Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust.

Conclusions: Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.

Keywords: China; benefit-cost analysis; diphtheria; diphtheria-tetanus-acellular pertussis vaccine; economic evaluation; pertussis; tetanus; vaccination; whole-cell pertussis vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
China / epidemiology
Cost-Benefit Analysis
Diphtheria-Tetanus-acellular Pertussis Vaccines*
Humans
Vaccination
Whooping Cough* / epidemiology
Whooping Cough* / prevention & control

Substances

Diphtheria-Tetanus-acellular Pertussis Vaccines