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J Gen Intern Med. 1993 Aug;8(8):405-12.

Should adult tetanus immunization be given as a single vaccination at age 65? A cost-effectiveness analysis.

Author information

1
Department of Medicine, Veterans Affairs Medical and Regional Office Center, White River Junction, VT 05009.

Abstract

OBJECTIVE:

To compare three vaccination strategies for the prevention of adult tetanus. Each strategy includes childhood primary immunization and wound prophylaxis, and one of the following: 1) the currently recommended booster every ten years; 2) a single booster at 65 years of age; or 3) no intervention after age 6 except for wound prophylaxis.

METHODS:

Cost-effectiveness analysis was used to compare the three different strategies. A Markov model, cycled annually from age 5 through age 85, was applied to each strategy to predict the incidence and costs of tetanus for the U.S. adult population.

RESULTS:

The three strategies have very similar effects on life expectancy but different costs. Expressed incremental to no intervention after childhood primary immunization, the decennial booster strategy is least cost-effective, with a discounted incremental cost-effectiveness ratio of $143,138 per year of life saved compared with $4,527 for the single-booster strategy. Sensitivity analysis demonstrates that the decennial strategy is more effective but more costly over a wide range of model assumptions.

CONCLUSIONS:

The current policy of recommending tetanus booster vaccinations every ten years is effective but much more costly than a more easily implemented policy that also provides considerable protection against tetanus. The authors recommend forsaking decennial boosters in favor of a policy of including a single booster at age 65 along with other recommended health maintenance maneuvers reserved for that age.

PMID:
8410405
DOI:
10.1007/bf02599616
[Indexed for MEDLINE]

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