Cost-Effectiveness of Maternal Tetanus Toxoid and Tetanus Diphtheria in Developing Countries: Systematic Review

Ana Claudia da Costa Guterres; Sri Annisa Jamarupada; Tiara Mudrika; Azizah Yuhani; Sulistyaningsih; Putri Listiani

doi:10.30994/jnp.v9i2.995

Authors

Ana Claudia da Costa Guterres Universitas Nasional Timor Lorosa'e
Sri Annisa Jamarupada Universitas Aisyiyah Yogyakarta
Tiara Mudrika Universitas Aisyiyah Yogyakarta
Azizah Yuhani Universitas Aisyiyah Yogyakarta
Sulistyaningsih Universitas Aisyiyah Yogyakarta
Putri Listiani Universitas Gadjah Mada

DOI:

https://doi.org/10.30994/jnp.v9i2.995

Keywords:

cost-effectiveness, developing countries, maternal immunization, tetanus toxoid, tetanus-diphtheria

Abstract

Background: Maternal and neonatal tetanus (MNT) remains a public health threat in low- and middle-income countries due to suboptimal coverage of complete-dose maternal immunization. Although TT and Td vaccines are clinically effective, their cost-effectiveness in different country contexts needs systematic assessment.

Purpose: To evaluate the cost-effectiveness of maternal tetanus toxoid (TT) and tetanus-diphtheria (Td) vaccination in developing countries, focusing on economic outcomes and contextual variations.

Methods: This systematic review followed PRISMA 2020 guidelines. Literature was searched in PubMed, Scopus, ScienceDirect, Wiley, and Crossref. Inclusion criteria comprised CEA/CUA studies on maternal TT/Td immunization in developing countries. Reporting quality was assessed using the CHEERS 2022 checklist.

Results: From 2,040 records, four studies met inclusion criteria. All reported maternal TT/Td vaccination as highly cost-effective, with ICERs ranging from USD 3.61 to 15,600 per DALY or life-year saved. Key uncertainties included vaccine effectiveness and distribution costs, while program efficiency varied by local health system conditions.

Conclusion: Complete-dose maternal TT/Td immunization is a highly cost-effective public health intervention in resource-limited settings. However, policy implementation must be adapted to local contexts and supported by robust sensitivity analysis and reliable primary data.

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