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

J Gen Intern Med. 1993 Aug;8(8):405-12. doi: 10.1007/BF02599616.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Humans
  • Immunization, Secondary / economics*
  • Immunization, Secondary / methods*
  • Middle Aged
  • Models, Statistical
  • Tetanus / economics
  • Tetanus / prevention & control*
  • Tetanus Toxoid / administration & dosage*
  • Value of Life


  • Tetanus Toxoid