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Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia.
Prehosp Disaster Med. 2015 Aug; 30(4):402-11.PD

Abstract

BACKGROUND

Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia. Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency.

METHODS

An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values.

RESULTS

Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden.

CONCLUSIONS

The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child's life, cost is reasonable, and herd immunity is possible.

Authors+Show Affiliations

1Division of Global Health Protection,Center for Global Health,Centers for Disease Control and Prevention,Atlanta,GeorgiaUSA.2Division of Bacterial Diseases,National Center of Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,GeorgiaUSA.1Division of Global Health Protection,Center for Global Health,Centers for Disease Control and Prevention,Atlanta,GeorgiaUSA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26061190

Citation

Gargano, Lisa M., et al. "Pneumonia Prevention During a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia." Prehospital and Disaster Medicine, vol. 30, no. 4, 2015, pp. 402-11.
Gargano LM, Hajjeh R, Cookson ST. Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia. Prehosp Disaster Med. 2015;30(4):402-11.
Gargano, L. M., Hajjeh, R., & Cookson, S. T. (2015). Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia. Prehospital and Disaster Medicine, 30(4), 402-11. https://doi.org/10.1017/S1049023X15004781
Gargano LM, Hajjeh R, Cookson ST. Pneumonia Prevention During a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia. Prehosp Disaster Med. 2015;30(4):402-11. PubMed PMID: 26061190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia. AU - Gargano,Lisa M, AU - Hajjeh,Rana, AU - Cookson,Susan T, Y1 - 2015/06/10/ PY - 2015/6/11/entrez PY - 2015/6/11/pubmed PY - 2015/12/15/medline KW - ARI acute respiratory infection KW - CFR case fatality rate KW - DALY disability-adjusted life-year KW - GAVI Global Alliance for Vaccines and Immunization KW - GDP gross domestic product KW - Haemophilus influenzae type b KW - Hib Haemophilus influenzae type b KW - ICER incremental cost-effectiveness ratio KW - IDP internally displaced person KW - PCV10 KW - PCV10 pneumococcal conjugate vaccine 10 KW - SIA supplemental immunization activity KW - Streptococcus pneumoniae KW - UN United Nations KW - UNHCR United Nations High Commissioner for Refugees KW - UNICEF UN Children’s Fund KW - WHO World Health Organization KW - cost-effectiveness KW - humanitarian emergency SP - 402 EP - 11 JF - Prehospital and disaster medicine JO - Prehosp Disaster Med VL - 30 IS - 4 N2 - BACKGROUND: Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia. Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency. METHODS: An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values. RESULTS: Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden. CONCLUSIONS: The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child's life, cost is reasonable, and herd immunity is possible. SN - 1049-023X UR - https://www.unboundmedicine.com/medline/citation/26061190/Pneumonia_Prevention_during_a_Humanitarian_Emergency:_Cost_effectiveness_of_Haemophilus_Influenzae_Type_B_Conjugate_Vaccine_and_Pneumococcal_Conjugate_Vaccine_in_Somalia_ L2 - https://www.cambridge.org/core/product/identifier/S1049023X15004781/type/journal_article DB - PRIME DP - Unbound Medicine ER -