An economic evaluation was performed of universal acellular pertussis vacci
nation in Italy, where until recently the overall coverage of pertussis vac
cination was estimated at 505. Over the last two years coverage seems to ha
ve increased rapidly. By means of a mathematical simulation model, the cons
equences of pertussis vaccination in terms of both health effects and econo
mic costs were calculated for a single birth cohort followed for 6 years. I
ncremental analyses were performed for each additional 10% increase in cove
rage from 50-90%. The results indicate that a 50% coverage rate of pertussi
s vaccination in Italy was not optimal on the basis of cost-effectiveness a
nd cost-benefit considerations. Additional increases in coverage were found
to yield extra health gains at modest net costs or even potential net savi
ngs to the health care sector. For example, an increase in coverage to 90%
would yield direct net savings of US$42 per extra vaccinee in comparison to
a situation of 50% coverage. The total net savings for this strategy would
be well over US$100 per additional vaccinee. In the sensitivity analysis,
the positive relationship between incremental coverage and incremental effi
ciency remained unchanged. (C) 1999 Elsevier Science Ltd. All rights reserv
ed.