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Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings.
Vaccine. 2017 06 14; 35(27):3506-3514.V

Abstract

BACKGROUND

Typhoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence.

METHODS AND FINDINGS

We evaluated routine infant vaccination with and without catch-up campaigns among older individuals. We used a dynamic model of typhoid transmission to simulate cases, hospitalizations, deaths, disability-adjusted life-years (DALY) lost, treatment and intervention costs. We estimated cost-effectiveness (in terms of cost in international dollars (I$) per DALY averted) from the healthcare payer perspective, and assessed how it was influenced by uncertain model parameters. Compared to no vaccination, routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, "very cost-effective" in Kolkata and Nairobi, and "cost-effective" in Lwak according to World Health Organization thresholds. However, routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being cost-saving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak. Vaccine price impacted the optimal strategy, and the number of doses required and rate of hospitalization were the primary sources of uncertainty.

CONCLUSION

Routine vaccination with TCV would be cost-effective in most settings, and additional one-time catch-up campaigns would also be economically justified.

Authors+Show Affiliations

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA. Electronic address: marina.antillon@yale.edu.Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA; Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium.Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520-8034, USA.Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA. Electronic address: virginia.pitzer@yale.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28527687

Citation

Antillón, Marina, et al. "Cost-effectiveness Analysis of Typhoid Conjugate Vaccines in Five Endemic Low- and Middle-income Settings." Vaccine, vol. 35, no. 27, 2017, pp. 3506-3514.
Antillón M, Bilcke J, Paltiel AD, et al. Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings. Vaccine. 2017;35(27):3506-3514.
Antillón, M., Bilcke, J., Paltiel, A. D., & Pitzer, V. E. (2017). Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings. Vaccine, 35(27), 3506-3514. https://doi.org/10.1016/j.vaccine.2017.05.001
Antillón M, et al. Cost-effectiveness Analysis of Typhoid Conjugate Vaccines in Five Endemic Low- and Middle-income Settings. Vaccine. 2017 06 14;35(27):3506-3514. PubMed PMID: 28527687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings. AU - Antillón,Marina, AU - Bilcke,Joke, AU - Paltiel,A David, AU - Pitzer,Virginia E, Y1 - 2017/05/17/ PY - 2017/02/05/received PY - 2017/04/28/revised PY - 2017/05/01/accepted PY - 2017/5/22/pubmed PY - 2018/2/13/medline PY - 2017/5/22/entrez KW - Conjugate vaccines KW - Cost-effectiveness studies KW - Low- and middle-income countries KW - Typhoid SP - 3506 EP - 3514 JF - Vaccine JO - Vaccine VL - 35 IS - 27 N2 - BACKGROUND: Typhoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. METHODS AND FINDINGS: We evaluated routine infant vaccination with and without catch-up campaigns among older individuals. We used a dynamic model of typhoid transmission to simulate cases, hospitalizations, deaths, disability-adjusted life-years (DALY) lost, treatment and intervention costs. We estimated cost-effectiveness (in terms of cost in international dollars (I$) per DALY averted) from the healthcare payer perspective, and assessed how it was influenced by uncertain model parameters. Compared to no vaccination, routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, "very cost-effective" in Kolkata and Nairobi, and "cost-effective" in Lwak according to World Health Organization thresholds. However, routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being cost-saving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak. Vaccine price impacted the optimal strategy, and the number of doses required and rate of hospitalization were the primary sources of uncertainty. CONCLUSION: Routine vaccination with TCV would be cost-effective in most settings, and additional one-time catch-up campaigns would also be economically justified. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/28527687/Cost_effectiveness_analysis_of_typhoid_conjugate_vaccines_in_five_endemic_low__and_middle_income_settings_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(17)30586-8 DB - PRIME DP - Unbound Medicine ER -