ECONOMIC-EVALUATION OF PERTUSSIS PREVENTION BY WHOLE-CELL AND ACELLULAR VACCINE IN GERMANY

Acellular pertussis vaccines are less reactogenic than whole cell pert ussis vaccines, but they are also more expensive. Based on simulation models, we compared the costs and effects of three alternative pertuss is 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% cove rage. In the two low coverage scenarios expected annual savings in dir ect medical costs through prevention of disease were larger for whole- cell than for acellular vaccination (252 vs 216 million DM, respective ly). Direct costs for treating the more important adverse events induc ed by whole-cell vaccination (16.9 million DM annually) did not outwei gh the higher direct costs of pertussis infections not prevented with the acellular vaccine and the higher price of the acellular vaccine. H owever, vaccination with acellular pertussis vaccine rapidly becomes a s cost saving as vaccination with whole-cell vaccine as soon as vaccin ation coverage can be raised from 45% to 52.5% with acellular vaccine. Acellular vaccination is also the superior alternative when consideri ng 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% in crease in coverage is achieved. If also non-medical indirect costs to parents resulting from vaccine associated side-effects are accounted f or, acellular vaccines may be more cost-effective also in countries wi th already high whole-cell vaccine coverage.