Journal of General Internal Medicine

, Volume 8, Issue 8, pp 405–412

Should adult tetanus immunization be given as a single vaccination at age 65?

A cost-effectiveness analysis
  • Dominic J. Balestra
  • Benjamin Uttenberg
Original Articles


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.

Key words

tetanus preventive medicine cost-benefit analysis immunization policy vaccines 


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Copyright information

© Hanley & Befus, Inc. 1993

Authors and Affiliations

  • Dominic J. Balestra
    • 1
  • Benjamin Uttenberg
    • 2
  1. 1.the Department of MedicineVeterans Affairs Medical and Regional Office CenterWhite River Junction
  2. 2.the Technology Assessment Program, Department of MedicineDartmouth-Hitchcock Medical CenterLebanon

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