| To Register SMDM Homepage | |
|
|
|
||||
Purpose: Vaccines are given to healthy individuals with the intention of preventing morbidity and mortality. When the disease the vaccine is targeting is exceedingly rare, like tetanus, the risks associated with immunization must be considered in the overall vaccine policy. Major authorities continue to recommend healthy adults receive tetanus booster vaccinations every 10 years. An alternative strategy of a single booster at 50 years of age may be as effective and safer. This study was done to determine which booster strategy is optimal.
Methods: We developed Markov cohort model to simulate the economic and clinical consequences (quality-adjusted life years) of 2 tetanus toxoid booster strategies using a hypothetical cohort of fully immunized 20 year olds: boosters every 10 years, or a booster once at 50 years. Data inputs were obtained from the literature for tetanus and vaccine adverse events. Costs in the model were limited to those for vaccines, medical care for tetanus infections, and for those related to vaccine adverse events.
Results: The decennial booster strategy was dominated by the strategy to give a booster once at age 50. The booster-at-50 alternative yielded 76.77 QALY and provided 2,000 (undiscounted) QALYs per 100,000 cohort members. It was cost saving at $188/QALY compared to $407/QALY for the decennial strategy. Results were insensitive to the utilities for tetanus or vaccine adverse events.
Conclusions: In settings where the incidence of tetanus is extremely rare, vaccine adverse events must be taken into account when recommending an appropriate booster policy. We show that the alternative booster strategy for once at age 50 is the optimal decision. Ensuring that everyone receives their primary tetanus vaccine series, boosters with wound management, and a single booster in mid adult life appears to be a safer, more cost-effective way to prevent tetanus infections in this country.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)