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Donatus U. Ekwueme, PhD; Peter M. Strebel, MD; Stephen C. Hadler, MD; Martin I. Meltzer, PhD; James W. Allen, MD; John R. Livengood, MD

Arch Pediatr Adolesc Med. 2000;154:797-803.

Objective  To compare the economic costs and benefits associated with using either diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) or diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) in the United States in 1997.

Design  Standard cost-benefit analysis, from both the societal and health care system perspectives, was performed for each combination vaccine as well as for the pertussis components singly.

Setting  A simulated cohort of 4.1 million children from birth to age 15 years.

Main outcome measures  Net costs (savings) and benefit-cost ratios (BCRs)

Results  Without a vaccination program, diphtheria, tetanus, and pertussis disease caused more than 3 million cases and more than 28,000 deaths, at a cost of $23.6 billion. From the societal perspective, net savings because of the use of DTaP and DTwP were $22.510 million and $22.623 million, respectively. The net savings from the acellular pertussis component and the whole-cell pertussis component only were $4.362 million and $4.474 million, respectively. Benefit-cost ratios for DTaP from a societal and health care system perspective were 27:1 and 9:1, respectively. Sensitivity analyses of key variables did not result in appreciable changes in results.

Conclusions  Compared with no program, vaccination with DTaP or DTwP resulted in substantial savings, regardless of the perspective taken and for all sensitivity analyses conducted. Compared with DTwP, use of DTaP generated a small cost increase that might be offset by the value of other factors, such as increased confidence in pertussis vaccination resulting from reduced adverse events.

From the National Immunization Program (Drs Ekwueme, Strebel, Hadler, and Livengood) and the National Center for Infectious Diseases (Dr Meltzer), Centers for Disease Control and Prevention, Atlanta, Ga; and the Occupational Health/Preventive Medicine Department, National Naval Medical Center, Washington, DC (Dr Allen).

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