Economic evaluation of adolescents and adults’ pertussis vaccination: A systematic review of current strategies

Figures & data

Figure 1. Flowchart of selection of studies included in the review.

Table 1. Methodological characteristics of the economic evaluations of pertussis vaccination for adolescents and adults.

Study/ Country	Year	Targeted population	Vaccination strategies compared	Type of study	Perspective	Model	Time horizon	Monetary unit / year	Health outcomes	Discount rate
Edmunds et al./ England and Wales^Citation14	2002	Pre-school Adolescents	(0) no vaccination; (1) vaccination at 4 years of age; (2) Adolescents vaccination	CEA	Healthcare provider and societal	Dynamic	Lifetime	UK£, 1999/2000	LYG	C and B – 3%
Scuffham e McIntyre/ Australia^Citation15	2004	Both parents after birth (cocooning) and neonates	(0) childhood vaccination; (1) at-birth immunization; (2) 1-month vaccination; (3) Cocooning	CEA	Healthcare system	Markov	6 months	AUS$, 2000	DALY	B – 3%
Purdy et al./ USA^Citation16	2004	Adolescents, adults (different ages) and healthcare workers	(0) no vaccination; (1) Adolescents vaccination; (2) Adults aged >20 years; (3) Adults aged >50 years; (4) Adults aged ≥18 years with chronic obstructive pulmonary disease; (5) Adults aged ≥15 years caretakers of infants <1 year of age; (6) Healthcare workers vaccination; (7) 10-year boosters	CBA	Societal	NR	10 years	US$, 2002	Cases prevented	C and B – 3%
Iskedjian et al./ Canada (Ontario)^Citation17	2004	Adolescents (12 years of age)	(0) No vaccination; (1) Adolescents vaccination	CEA	Ministry of Health and societal	Dynamic	10 years	CAD$, 2003	Cases prevented	C – 3%
Caro et al./ USA^Citation18	2005	Adolescents (11–18 years)	(0) no vaccination; (1) Adolescents vaccination	CEA	Healthcare payer and societal	Cohort Simulation	Lifetime	US$, 2002	LYG	B – 3%
Iskedjian et al./ Canada (Quebec)^Citation19	2005	Adolescents (14 years of age)	(0) no vaccination; (1) Adolescents vaccination	CEA	Ministry of Health and societal	Dynamic	10 years	CAD$, 2003	Cases prevented	C – 3%
Lee et al./ USA^Citation20	2005	Adolescents (11 years of age); adults (20 years of age); mothers immediately after birth and all other close contacts before the birth (cocooning)	(0) no vaccination; (1) Adolescent vaccination; (2) one-time adult vaccination; (3) adult vaccination with 10-year boosters; (4) Adolescent + adult + 10-year boosters; (5) Cocooning	CEA	Healthcare payer and societal	Markov	Lifetime	US$, 2004	Cases prevented and QALY	C and B – 3%
Calugar et al./ USA^Citation21	2006	Healthcare workers	(0) No vaccination; (1) Healthcare workers vaccination	CBA	Hospital perspective	Dynamic	10 years	US$, 2004	Exposures to pertussis cases prevented	C and B – 3%
Lee et al./ USA^Citation22	2007	Adults	(0) No vaccination; (1) Adult vaccination; (2) 10-year boosters	CEA	Societal	Markov	Lifetime	US$, 2005	Cases prevented and QALY	C and B – 3%
Lee et al./ Germany^Citation23	2008	Adults	(0) No vaccination; (1) One-time adult vaccination at 20–64 years of age; (2) 10-year boosters	CEA	Healthcare payer and societal	Markov	Lifetime	€, 2006	Cases prevented and QALY	C and B – 3%
Coudeville et al./ USA/ 2009^Citation24	2009	Adolescents, adults and both parents after birth (cocooning)	(0) No vaccination; (1) Adolescents vaccination; (2) Adolescents vaccination + cocooning; (3) Adolescents + adult + cocooning; (4) Adolescents + adults + 10-year boosters	CEA	Societal	Dynamic	100 years	US$, 2006	LYG	C and B – 3%
Westra et al./ Netherlands^Citation25	2010	Father before and mother after the delivery (cocooning), pregnant women and neonates	(0) No vaccination; (1) Vaccination at birth; (2) Cocooning; (3) Pregnant women; (4) combining (2)+(3)	CEA	Healthcare payer and societal	Decision-tree	8 years	€ and US$, 2008 (1 € = 1.4 US$)	QALY	C – 4%, B – 1.5%
de Vries et al./ Netherlands^Citation26	2010	Adolescents (12 years of age)	(0) No vaccination (1) Adolescents vaccination	CEA	Societal	Dynamic	25 years	€, 2008	QALY	C – 4%, B – 1.5%
Greer and Fisman/ Canada^Citation27	2011	Healthcare workers	(0) No vaccination; (1) Healthcare workers vaccination	CEA	Societal	Markov	10 years	US$, 2008	QALY	B – 3%
Rozenbaum et al./ Netherlands^Citation28	2012	Adolescents and adults	(0) No vaccination; (1) A single dose for adolescents or adults; (2) single dose for both adolescents and adults vaccination; (3) booster doses with 10-year intervals	CEA	Societal	Dynamic	25 years	€, 2011	QALY	C – 1.5%, B – 4%
Itatani et al./ Japan^Citation29	2013	Adolescents, adults and both parents after birth (cocooning)	(0) No vaccination; (1) Adolescents vaccination; (2) Adolescents + 10-year booster; (3) Adolescents + cocooning	CEA	Societal	Markov	40 years	Yen	QALY	C and B – 3%
Meregaglia et al./ Italy^Citation30	2013	Both parents and other close contacts during pregnancy or immediately after delivery (cocooning)	(0) No vaccination; (1) Cocooning	CEA CBA	National Health Service	NR	1 year	€, 2011	Cases prevented	Not considered
Ding et al./ USA^Citation31	2013	Mothers after birth	(0) No vaccination; (1) Postpartum maternal vaccination	CBA	Healthcare system and societal	Decision tree	10 years	US$, 2012	Cases and deaths prevented	C – 3%
Terranella et al./ USA^Citation32	2013	Mothers immediately after birth, all other close contacts vaccinated before the birth (cocooning) and pregnant women	(0) No vaccination; (1) Pregnant women; (2) Postpartum maternal vaccination; (3) Cocooning	CEA	Societal	Markov	1 year	US$, 2011	Cases averted, QALY and LYG	C and B – 3%
Lugnér et al./ Netherlands^Citation33	2013	Both parents after birth (cocooning), pregnant women and neonates	(0) No vaccination; (1) neonate immunization at birth; (2) cocooning; (3) Pregnant women.	CEA	Societal	NR	10 years	€, 2009	QALY	C – 4%, B – 1.5%
McGarry et al./ USA^Citation34	2013	Adults aged ≥65 years	(0) No vaccination; (1) Adults vaccination	CEA	Healthcare payer and societal	Decision tree	35 years	US$, 2010	Cases prevented and QALY	C and B – 3%
McGarry et al./ USA^Citation35	2014	Adults aged ≥65 years	(0) No vaccination; (1) Adults vaccination	CEA	Healthcare payer and societal	Dynamic	Lifetime	US$, 2010	QALY	B – 3%
Fernández-Canoa et al./ Spain^Citation36	2015	Both parents after birth (cocooning) and pregnant women	(0) No vaccination; (1) Cocooning; (2) Pregnant women	CBA	Healthcare system	Decision tree	1 year	€, 2012	Hospitalizations and cases prevented	Not considered
Kamiya et al./ USA^Citation37	2016	Adolescents and adults	(0) No revaccination; (1) Adolescent revaccination; (2) Adult revaccination	CEA	Society	Decision tree	20 years	US$, 2010	Cases prevented and QALY	C and B – 3%
Atkins et al./ USA^Citation38	2016	Adults, both parents (cocooning) and pregnant women	(0) No vaccination; (1) Adult vaccination; (2) Mother antepartum and (3) postpartum vaccination; (4)Both parents antepartum and (5) postpartum	CEA	Healthcare provider	Dynamic	20 years	US$, 2013	QALY	C and B – 3%
Sartori et al./ Brazil^Citation39	2016	Pregnant women	(0) No vaccination; (2) Pregnant women	CEA	Healthcare system and societal	Decision tree	1 year	US$, 2011	Cases and deaths prevented and LYG	Not considered
Hoek et al./ England^Citation40	2016	Pregnant women	(1) No vaccination; (2) Pregnant women	CEA	Healthcare payer	Dynamic	5, 10, 30 and 200 years	UK£ (reference year not reported)	QALY	C -1.5%, B - 3.5%

C: Costs; B: Benefits; CEA: cost-effectiveness analyses; CBA: cost-benefit analyses; CUA: cost-utility analyses; LYG: life year gained; QALY: quality-adjusted life year; LYG: Life of years gained; NR: Not Reported

Table 2. Characteristics of vaccines and vaccination programs used in the economic evaluations of pertussis vaccination for adolescents and adults.

Study	Vaccine coverage	Vaccine efficacy /effectiveness	Adverse events following immunization	Duration of protection / Waning Immunity	Herd protection
Edmunds et al.^Citation14	84%	95%	NC	5 years	Yes
Scuffham e McIntyre^Citation15	95% (adults)	Adults 75%; At birth 67%; 1-month 75%	NC	NC	No
Purdy et al.^Citation16	40% (adolescents and adults)	88%	1%	10 years	No
Iskedjian et al.^Citation17	95%	85%	NC	NC	No
Caro et al.^Citation18	80%	85%	2%	10 years	Yes
Iskedjian et al.^Citation19	85%	85%	NC	NC	Not
Lee et al.^Citation20	Coverage by age: 10 years 76%; 20 years 36%; 30 years 34%; 40 years 29%; 50 years 21%; 60 years 14%; 70 years 5%; postpartum 66%	100%	Local reaction 2%; Systemic reaction 1%; Anaphylaxis 0.0001%	15 years	Yes
Calugar et al.^Citation21	66%	71.4%	Anaphylaxis 0.0001%	10 years	No
Lee et al.^Citation22	20–49 years of age: 66%; 50–64 years of age: 57%	87%	Local reactions: 2%; Systemic reactions: 1%; Anaphylaxis: 0,0001%	15 years	Yes
Lee et al.^Citation23	Coverage by age: 20 years 82%; 30 years 58%; 40 years 40%; 50 years 75%; 60 years 62%	87%	Local reactions 2%. Systemic reactions 1%. Anaphylaxis 0,0001%	15 years	Yes
Coudeville et al.^Citation24	Adolescents 75%; adults 40%; cocooning 65%	92%	Additional medical consultations for AEFI (2%) in vaccination cost	12 years	Yes
Westra et al.^Citation25	96%	89%	NC	4 months (persistence of maternal antibodies in infants)	No
de Vries et al.^Citation26	96%	89%	NC	Two scenarios: 8 and 15 years	Yes
Greer and Fisman^Citation27	25 to 95%	100%	Anaphylaxis 0.00001%	NC	No
Rozenbaum et al.^Citation28	70%	89%	NC	10 years	Yes
Itatani et al.^Citation29	11–12 years of age 70%; >12 years 20%	85%	Severe (anaphylaxis) 0.0001%; moderate 2%	10 years	No
Meregaglia et al.^Citation30	NR	89%	NC	NC	No
Ding et al.^Citation31	25 to 60%	80%	Local reaction 2%; Systemic reaction 1%; Anaphylaxis 0.0001%	10 years	No
Terranella et al.^Citation32	72%	Adults vaccination: 85%; Efficacy of maternal vaccination on newborn protection 60%	NC	2 months (persistence of maternal antibodies in infants)	No
Lugnér et al.^Citation33	75%	89%	NC	5 years	No
McGarry et al.^Citation34	10%	89%	Included in the vaccine cost	8 years	No
McGarry et al.^Citation35	10% (at 65 years of age)	89%	Included in the vaccine cost	8 years	Yes
Fernández-Canoa et al.^Citation36	50%, 80% and 100%	Adults vaccination: 85% Efficacy of maternal vaccination on newborn protection 60%	NC	2 months (persistence of maternal antibodies in infants)	No
Kamiya et al.^Citation37	Coverage by age: 11 years 78%; 16 years 50%; 21 years 64%	74%	Medically-attended allergic reactions 0.003%; Anaphylaxis 0.00006%	15% decrease of vaccine effectiveness each year post-vaccination	No
Atkins et al.^Citation38	75%	Adults vaccination: 100%; Maternal vaccination on newborn protection 89%	US$0.93 added to vaccination cost	2.7 years	Yes
Sartori et al.^Citation39	57%	78%	NC	6 months (duration of maternal antibody protection); 4 months in SA	No
Hoek et al.^Citation40	60%	Infants 91%; Mother 89%	NC	3 months (persistence of maternal antibodies); 5 years among adults	No

NC – Not Considered; NR – not reported: SA – Sensitivity analyses; AEFI - adverse event following vaccination

Table 3. Pertussis incidence and underreporting correction factor used in economic evaluations of pertussis vaccination for adolescents and adults.

Study	Incidence rates by age groups	Source of incidence data	Strategies to account for underreporting	Source of correction factor
Edmunds et al.^Citation14	Consultation rates: <3 months: 38.58/100,000; 3 months to 4 years: 107.88/100,000; 5 to 14 years: 49.27/100,000; 15 to 44 years: 5.33/100,000; >45 years: 2.21/100,000	Royal College of General Practioners Weekly Returns Service (RCGP); Hospital Episode Statistics (HES);Office of National Statistics (ONS)	Used correction factor of 2.5	Authors’ assumption
Scuffham e McIntyre^Citation15	5.171 notified cases / 100,000 infants per week	Health Outcomes Information Statistical Toolkit of the New South Wales Department Australian Childhood Immunization register	Not considered	Not considered
Purdy et al.^Citation16	Adolescents and adults: 450/100,000 person-years; distribution by age: 10–19 years: 41%; 20–29 years: 7%; 30–39 years: 17%; 40–49 years: 28%	Centers for Disease Control and Prevention; Acellular Pertussis Vaccine Trial (APERT) (clinical trial).	Children aged 0–9 years: correction factor of 2	Authors’ assumption
Iskedjian et al.^Citation17	Adolescents aged 12–17 years: 511/100,000; Adults aged 18–21 years: 65/100,000	Health Canada	Adolescents: correction factor of 9	Enhanced surveillance with serosurvey
Caro et al.^Citation18	0.2–57/100,000 (age-specific rates used)	Centers for Disease Control and Prevention	Used correction factor of 7.6	Local study using capture-recapture methods to analyze morbidity data from independent surveillance systems
Iskedjian et al.^Citation19	Adolescents (14–17 years) 511/100,000; Adults (18–24 years) 65/100,000	Health Canada	Used correction factor of 9	Enhanced surveillance with serosurvey
Lee et al.^Citation20	Infants 58.5/100,000; Adolescents 155/100,000; Adults 11/100,000	Massachusetts Department of Public Health (pertussis surveillance data)	Not considered	Not considered
Calugar et al.^Citation21	Proportion of infections in healthcare workers: 6.75%	Two local studies	Not considered	Not considered
Lee et al.^Citation22	Incidence in adults ranged from 10 to 500/100,000; Infants 58.5/100,000	Infants: 2 local studies; Adults: Massachusetts Department of Public Health (official data)	Range of incidences	Tdap efficacy study; 3 studies of pertussis prevalence among persons with cough
Lee et al.^Citation23	Adults 165/100,000; Adolescents 95/100,000; Infants 22/100,000.	Adults: Local study (17160764); Adolescents and infants: governmental epidemiological data	Adults’ Incidence varied from 50 to 500 / 100,000 in sensitivity analysis	Studies in Europe and USA
Coudeville et al.^Citation24	Adult cases requiring medical care 90/ 100,000	Acellular Pertussis Vaccine Trial (APERT) and Centers for Disease Control and Prevention (CDC)	Children data were adjusted using age-specific underreporting estimates (data not shown)	Capture-recapture study
Westra et al.^Citation25	Incidence in infants <1 year of age: 129/100,000. Distribution of cases among infants <1 year: 0 months: 7.0%; 1 month: 21.4%; 2 months: 18.1%; 3 months: 11.2%; 4 months: 5.3%; 5 months: 2.7%; 6 months: 7.8%; 7 months: 4.2%; 8 months: 8.0%; 9 months: 5.5%; 10 months: 5.0%; 11 months: 3.8%. Incidence in adults 25–34 years of age: 17.9/100,000	Centre for Infectious Disease Control of the Dutch National; Institute for Public Health and the Environment	Adults: correction factor of 200 Children: no correction	Serological survey and dynamic transmission model study
de Vries et al.^Citation26	Age specific (data not shown)	RIVM report – Rijksinstituut voor Volksgezondheid en Milieu	Age specific correction factor of (up to 660)	Serological survey
Greer and Fisman^Citation27	Average number of exposures/case: 8.73 Symptomatic adults: 40%	Data from a real outbreak	Not considered	Not considered
Rozenbaum et al.^Citation28	<1 year: 200/100,000 5 years: 100/100,000 ≥15 years: 50/100,000	Surveillance data from 1996 to 2001	Used correction factor of 600	Serological survey
Itatani et al.^Citation29	Incidence rates ranged from 25 to 250/100,000 person-years	Japan’s Infectious Disease Surveillance Centre	Range of incidences	Previous studies from USA, Germany and Canada
Meregaglia et al.^Citation30	Infants: 54/100,000 hospitalizations/year	Regional hospital discharge database	Not considered	Not considered
Ding et al.^Citation31	Mothers – 450/100,000. Infants aged <6 months – 71.6/100,000	Mothers: local study. Infants: Surveillance data (California Department of Public Health and Centers for Disease Control and Prevention (CDC)	Not considered	Not considered
Terranella et al.^Citation32	<1 year: 62.6/100,000; Incidence by month of age (/100,000) < 1: 12.4; 1: 18.9; 2: 15.3; 3: 8.9; 4: 5.7; 5: 3.2; 6: 2.4; 7: 1.6; 8: 1.5; 9: 1.4; 10: 1.1; 11: 1.4	National Notifiable Diseases Surveillance System (NNDSS), 2000 – 2007.	Increase of 15%	Authors’ assumption
Lugnér et al.^Citation33	<5 years-old: 130/100,000; 20 – 40 years-old women: 2,606/100,000	Statistics Netherlands	100 x the surveillance data	Serological surveys
McGarry et al.^Citation35	Different incidence rates were considered: 25, 50, 100, 150, and 200/100,000	Centers for Disease Control and Prevention, California Department of Public Health Pertussis Report 2011, Washington State Department of Health (2012)	Different incidence rates were used	Tdap efficacy study; 3 studies of pertussis prevalence among persons with cough
McGarry et al.^Citation35	Incidence rate by age (/100,000) <1 year: 435.00; 1–6 years: 61.8; 7–9 years: 67.3; 10–18 years: 49.0; 19–64 years: 124.15; ≥65 years: 86.08	California Department of Public Health surveillance data; Centers for Disease Control and Prevention (CDC).	For adults ≥65 years, data was inflated, assuming 1% reporting	2009 Centers for Disease Control and Prevention (CDC)
Fernández-Canoa et al.^Citation36	Hospitalization by age-group 0–2 months – 119/100,000; 3–4 months – 26/100,000 ; 5–6 months – 5/100,000; 7–11 months – 4/100,000; <1 year – 153/100,000	Hospitalization data of Spanish Government (MBDS), from 2009 to 2011.	Not considered	Not considered
Kamiya et al.^Citation37	Age-specific; 11–30 years (data not shown)	National Notifiable Diseases Surveillance System – NNDSS 2002–2011	Used correction factor of 20–200 in sensitivity analysis	Several studies and authors’ assumptions
Atkins et al.^Citation38	The model was calibrated to USA incidence data from 2003–2012 (data not shown)	Centers for Disease Control and Prevention (CDC)	The authors combined data of reported case, hospitalization rates, reporting rates for hospitalized cases, and active surveillance of non-hospitalized cases (data not shown)	CDC, Wisconsin Department of Health Services, and local study
Sartori et al.^Citation39	Children aged <1 year-old: 55.407/100,000	National Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN)	Not considered	Not considered
Hoek et al.^Citation40	Infants aged <3 months: ~ 0.5 to ~ 45/100,000; Women aged 20 – 44 years: 0 to ~ 40/100,000	Number of hospitalization from 2010 to 2012 (NHS)	Not considered	Not considered

Table 4. Summary measures (Incremental Cost-Effectiveness Ratio, ICER, or Cost-Benefit ratio) presented in results of economic evaluations of pertussis vaccination for adolescents and adults, according to the perspective.

Study	Societal*	Health care provider*	Sponsor
Edmunds et al.^Citation14	9,278.21/LYG	18,047.45/LYG	Medical Research Council
Scuffham e McIntyre^Citation15	Not considered	1,562,146.18/DALY	Commonwealth Department of Health and Ageing
Purdy et AL.^Citation16	Cost preventable (billions of US$)/ break-even (US$) Adolescent vaccination: US$0.4 to 2.1 billons/ US$49.12	Not considered	GlaxoSmithKline
Iskedjian et al.^Citation17	Cost-saving	274.77/case prevented	Sanofi-Pasteur
Caro et al.^Citation18	6,322.19/LYG	29,310.66/ LYG	NR
Iskedjian et al.^Citation19	374.13/ case prevented	476.35/case prevented	Sanofi-Pasteur
Lee et al.^Citation20	Adolescents vaccination: 25,244.96/QALY;	Adolescents vaccination: 29,031.70/QALY;	National Immunization Program, Centers for Disease Control and Prevention, Association of Teachers of Preventive Medicine, National Vaccine Program Office Agency for Healthcare Research and Quality
Calugar et al.^Citation21	Not considered	Cost-benefit ratio: 3	Centers for Disease Control and Prevention and St. Luke’s Hospital
Lee et al.^Citation22	Adult vaccination: 13,539.39/ QALY; 10-year boosters: 14,770.25/QALY	Not considered	Agency for Healthcare Research and Quality, National Immunization Program, Centers for Disease Control and Prevention Association of Teachers of Preventive Medicine
Lee et al.^Citation23	Adult vaccination: 8,796.50/QALY. 10-year boosters: 10,919.79 /QALY	Adult vaccination: 31,919.79 /QALY. 10-year boosters:40,949.25/QALY	Agency for Healthcare Research and Quality, US Department of Health and Human Services
Coudeville et al.^Citation24	Cost-saving	Not considered	Sanofi-Pasteur
Westra et al.^Citation25	Cost-saving	Cocooning: 6,234.84/QALY; Pregnant women: 4,743.90/QALY	GlaxoSmithKline
de Vries et al.^Citation26	5,988.16/QALY and 8,635.27/QALY (for duration of protection after vaccination of 8 and 15 years, respectively)	Not considered	GlaxoSmithKline
Greer and Fisman^Citation27	Cost-saving	Not considered	Ontario Early Researcher Award Sanofi-Pasteur
Rozenbaum et al.^Citation28	Single (3rd) booster for adolescents or adults: 7,292.58/QALY; Adolescent + adult vaccination: 13,022.47/QALY. 10-year booster: 21,971.53 /QALY	Not considered	NR
Itatani et al.^Citation29	Adolescents’ vaccination: 36.24/QALY; Adolescents + 10-year boosters: dominated; Adolescents + cocooning: 2,432.54/QALY	Adolescents vaccination: 51.21/QALY; Adolescents + 10-year boosters: dominated; Adolescents + cocooning: 2,496.61/QALY	NR
Meregaglia et al.^Citation30	Not considered	32%: 246,490.46/case prevented	NR
Ding et al.^Citation31	Expected Net of Benefit US$61.25/vaccinated mother	Expected Net of Benefit US$37.25/ vaccinated mother	Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services
Terranella et al.^Citation32	Pregnant women: 439,708.46/QALY. Cocooning: 2,127,816.28/QALY	Not considered	NR
Lugnér et al.^Citation33	Cocooning: 120,828.15/QALY; Pregnant women: 171,060.07/QALY.	Not considered	National Institute for PublicHealth and the Environment, Bilthoven, Netherlands
McGarry et al.^Citation34	ICER per disease incidence (/100.000): 25: 369,229.63/QALY; 100: 68,896.32/QALY; 200: 18,675.26/QALY.	“similar results”	GlaxoSmithKline
McGarry et al.^Citation35	Cost-saving	Cost-saving	GlaxoSmithKline
Fernández-Canoa et al.^Citation36	Not considered	Benefit-to-cost ratio: Cocooning: 0.4; Pregnant women: 0.15.	NR
Kamiya et al.^Citation37	Adolescents vaccination: 21,672,785.63/QALY Adult vaccination: 28,752,816.66/QALY	Not considered	Centers for Disease Control and Prevention
Atkins et al.^Citation38	Not considered	Pregnant women: 116,902.95/QALY; Both parents: 835,056,23/QALY (antepartum) and dominated (postpartum); Adult vaccination: dominated	Notsew Orm Sands Foundation (Houston, Texas) and Sanofi-Pasteur
Sartori et al.^Citation39	17,217.25/LYG	17,237.13/LYG	Brazilian Ministry of Health/Pan American Health Organization
Hoek et al.^Citation40	Not considered	60,619.60/QALY	National Institute for Health Research Health Protection Research Unit

*Summary measures were adjusted to 2016 values and then converted to international dollar units using Purchasing Power Parity (PPP).

NR: Not reported; LYG: Life years gained; QALY: Quality adjusted life years; DALY: Disability adjusted life year

Table

Database	Search strategy
MEDLINE	((((((((((((((((((((((((((Economics[MeSH Terms]) OR Economics, Pharmaceutical[MeSH Terms]) OR ((cost and cost analysis[MeSH Terms]))) OR cost of illness[MeSH Terms]) OR cost benefit analyses[MeSH Terms]) OR health care cost[MeSH Terms]) OR analyses, cost benefit[MeSH Terms])) OR ““analysis cost-benefit”“) OR ““cost benefit analysis”“) OR ““analyses, cost benefit”“) OR ““analysis, cost benefit”“) OR ““cost benefit analyses”“) OR ““cost effectiveness”“) OR ““effectiveness, cost”“) OR ““cost-utility analysis”“) OR ““analysis, cost-utility”“) OR ““cost utility analysis”“) OR ““economic, evaluation”“) OR ““evaluation economic”“) OR ““cost benefit”“) OR ((““cost and benefit”“))) OR ((““benefit and cost”“))) OR ““cost effectiveness-analysis”“) OR ““analysis, cost-effectiveness”“) OR ““cost effectiveness analysis”“)) AND (“pertussis” OR pertussis[MeSH Terms] OR pertussis vaccine[MeSH Terms] OR “pertussis vaccine” OR “Diphtheria-Tetanus-acellular Pertussis Vaccines” OR ““Diphtheria-Tetanus-acellular Pertussis Vaccines”“[MeSH Terms])
EMBASE	(‘diphtheria pertussis tetanus vaccine’ OR ‘pertussis’ OR ‘pertussis vaccination’ OR ‘pertussis vaccine’) AND (‘biomedical technology assessment’/exp OR ‘cost utility analysis’/exp OR ‘cost of illness’/exp OR ‘cost minimization analysis’/exp OR ‘pharmacoeconomics’/exp OR ‘cost benefit analysis’/exp)
CDR	(PERTUSSIS) OR (PERTUSSIS VACCINE) OR (Diphtheria-Tetanus-acellular Pertussis Vaccines) IN DARE, NHSEED, HTA
Lilacs	((tw:(Pertussis Vaccine)) OR (tw:(Diphtheria-Tetanus-Pertussis Vaccine)) OR (tw:(Whooping Cough)) OR (tw:(Diphtheria-Tetanus-acellular Pertussis Vaccines)) AND (tw:(Pharmaceutical Economics)) OR (tw:(Pharmacoeconomics)) OR (tw:(Cost-Benefit Analysis)) OR (tw:(Cost-Effectiveness Evaluation)) OR (tw:(cost effectiveness)))

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