Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1650-1655 (doi:10.1542/peds.2005-0822)
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Economic Analysis of Prevaccination Serotesting Compared With Presumptive Immunization for Polio, Diphtheria, and Tetanus in Internationally Adopted and Immigrant Infants

Adam L. Cohen, MD, MPHa and David Veenstra, PharmD, PhDb

a Child Health Institute, Department of Pediatrics
b Department of Pharmacy, University of Washington, Seattle, Washington

BACKGROUND. No consensus exists about whether to conduct prevaccination serotesting or to presumptively vaccinate internationally adopted and immigrant infants with inactivated polio (IPV) and diphtheria-tetanus-acellular pertussis (DTaP) immunizations.

OBJECTIVE. To study the clinical and economic outcomes from a societal perspective of prevaccination serotesting in a hypothetical 12-month-old internationally adopted or immigrant infant.

DESIGN AND METHODS. A decision analysis model was developed comparing presumptive vaccination with IPV versus serotesting for poliovirus type 1, 2, and 3 antibodies followed by vaccination in unprotected patients. A similar decision analysis model was developed comparing presumptive vaccination with DTaP versus serotesting for diphtheria and tetanus toxoid antibodies. The main outcome measures were cost per patient protected from polio, diphtheria, and tetanus.

RESULTS. Compared with presumptive immunization, prevaccination serotesting for polio increases the cost per patient from $57 to $62 and decreases the percentage of patients protected against polio from 95.3% to 94.0%. Serotesting for diphtheria and tetanus increases the cost per patient from $62 to $119 and increases the percentage of patients protected against both diphtheria and tetanus from 91.5% to 92.3%. Presumptive immunization with DTaP costs less and is more clinically effective than serotesting if >80% of patients do not complete the full vaccine series or if antibody seroprevalence to both diphtheria and tetanus is <51%.

CONCLUSIONS. Presumptive immunization for polio improves outcomes and saves costs compared with prevaccination serotesting in internationally adopted and immigrant infants. The results for DTaP are less definitive, although immunization is the preferred strategy in populations with poor vaccine compliance or low seroprevalence of antibodies to diphtheria and tetanus.

Key Words: international adoption • immunizations • cost-effectiveness • cost analysis • immigration issues

Abbreviations: Hib—Haemophilus influenzae type b • IPV—inactivated polio • DTaP—diphtheria-tetanus-acellular pertussis

Accepted Oct 31, 2005.


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 Arch Pediatr Adolesc MedHome page
E. Verla-Tebit, X. Zhu, E. Holsinger, and A. M. Mandalakas
Predictive Value of Immunization Records and Risk Factors for Immunization Failure in Internationally Adopted Children
Arch Pediatr Adolesc Med, May 1, 2009; 163(5): 473 - 479.
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