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Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study.
Lancet Infect Dis. 2019 07; 19(7):728-739.LI

Abstract

BACKGROUND

Typhoid fever is a major cause of morbidity and mortality in low-income and middle-income countries. In 2017, WHO recommended the programmatic use of typhoid Vi-conjugate vaccine (TCV) in endemic settings, and Gavi, The Vaccine Alliance, has pledged support for vaccine introduction in these countries. Country-level health economic evaluations are now needed to inform decision-making.

METHODS

In this modelling study, we compared four strategies: no vaccination, routine immunisation at 9 months, and routine immunisation at 9 months with catch-up campaigns to either age 5 years or 15 years. For each of the 54 countries eligible for Gavi support, output from an age-structured transmission-dynamic model was combined with country-specific treatment and vaccine-related costs, treatment outcomes, and disability weights to estimate the reduction in typhoid burden, identify the strategy that maximised average net benefit (ie, the optimal strategy) across a range of country-specific willingness-to-pay (WTP) values, estimate and investigate the uncertainties surrounding our findings, and identify the epidemiological conditions under which vaccination is optimal.

FINDINGS

The optimal strategy was either no vaccination or TCV immunisation including a catch-up campaign. Routine vaccination with a catch-up campaign to 15 years of age was optimal in 38 countries, assuming a WTP value of at least US$200 per disability-adjusted life-year (DALY) averted, or assuming a WTP value of at least 25% of each country's gross domestic product (GDP) per capita per DALY averted, at a vaccine price of $1·50 per dose (but excluding Gavi's contribution according to each country's transition phase). This vaccination strategy was also optimal in 48 countries assuming a WTP of at least $500 per DALY averted, in 51 with assumed WTP values of at least $1000, in 47 countries assuming a WTP value of at least 50% of GDP per capita per DALY averted, and in 49 assuming a minimum of 100%. Vaccination was likely to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years. Uncertainty about the probability of hospital admission (and typhoid incidence and mortality) had the greatest influence on the optimal strategy.

INTERPRETATION

Countries should establish their own WTP threshold and consider routine TCV introduction, including a catch-up campaign when vaccination is optimal on the basis of this threshold. Obtaining improved estimates of the probability of hospital admission would be valuable whenever the optimal strategy is uncertain.

FUNDING

Bill & Melinda Gates Foundation, Research Foundation-Flanders, and the Belgian-American Education Foundation.

Authors+Show Affiliations

Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium. Electronic address: joke.bilcke@uantwerpen.be.Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Center for Statistics, I-Biostat, Hasselt University, Diepenbeek, Belgium.Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK.Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA.Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA. Electronic address: virginia.pitzer@yale.edu.

Pub Type(s)

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

Language

eng

PubMed ID

31130329

Citation

Bilcke, Joke, et al. "Cost-effectiveness of Routine and Campaign Use of Typhoid Vi-conjugate Vaccine in Gavi-eligible Countries: a Modelling Study." The Lancet. Infectious Diseases, vol. 19, no. 7, 2019, pp. 728-739.
Bilcke J, Antillón M, Pieters Z, et al. Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study. Lancet Infect Dis. 2019;19(7):728-739.
Bilcke, J., Antillón, M., Pieters, Z., Kuylen, E., Abboud, L., Neuzil, K. M., Pollard, A. J., Paltiel, A. D., & Pitzer, V. E. (2019). Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study. The Lancet. Infectious Diseases, 19(7), 728-739. https://doi.org/10.1016/S1473-3099(18)30804-1
Bilcke J, et al. Cost-effectiveness of Routine and Campaign Use of Typhoid Vi-conjugate Vaccine in Gavi-eligible Countries: a Modelling Study. Lancet Infect Dis. 2019;19(7):728-739. PubMed PMID: 31130329.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study. AU - Bilcke,Joke, AU - Antillón,Marina, AU - Pieters,Zoë, AU - Kuylen,Elise, AU - Abboud,Linda, AU - Neuzil,Kathleen M, AU - Pollard,Andrew J, AU - Paltiel,A David, AU - Pitzer,Virginia E, Y1 - 2019/05/23/ PY - 2018/08/28/received PY - 2018/12/10/revised PY - 2018/12/14/accepted PY - 2019/5/28/pubmed PY - 2020/6/10/medline PY - 2019/5/28/entrez SP - 728 EP - 739 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 19 IS - 7 N2 - BACKGROUND: Typhoid fever is a major cause of morbidity and mortality in low-income and middle-income countries. In 2017, WHO recommended the programmatic use of typhoid Vi-conjugate vaccine (TCV) in endemic settings, and Gavi, The Vaccine Alliance, has pledged support for vaccine introduction in these countries. Country-level health economic evaluations are now needed to inform decision-making. METHODS: In this modelling study, we compared four strategies: no vaccination, routine immunisation at 9 months, and routine immunisation at 9 months with catch-up campaigns to either age 5 years or 15 years. For each of the 54 countries eligible for Gavi support, output from an age-structured transmission-dynamic model was combined with country-specific treatment and vaccine-related costs, treatment outcomes, and disability weights to estimate the reduction in typhoid burden, identify the strategy that maximised average net benefit (ie, the optimal strategy) across a range of country-specific willingness-to-pay (WTP) values, estimate and investigate the uncertainties surrounding our findings, and identify the epidemiological conditions under which vaccination is optimal. FINDINGS: The optimal strategy was either no vaccination or TCV immunisation including a catch-up campaign. Routine vaccination with a catch-up campaign to 15 years of age was optimal in 38 countries, assuming a WTP value of at least US$200 per disability-adjusted life-year (DALY) averted, or assuming a WTP value of at least 25% of each country's gross domestic product (GDP) per capita per DALY averted, at a vaccine price of $1·50 per dose (but excluding Gavi's contribution according to each country's transition phase). This vaccination strategy was also optimal in 48 countries assuming a WTP of at least $500 per DALY averted, in 51 with assumed WTP values of at least $1000, in 47 countries assuming a WTP value of at least 50% of GDP per capita per DALY averted, and in 49 assuming a minimum of 100%. Vaccination was likely to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years. Uncertainty about the probability of hospital admission (and typhoid incidence and mortality) had the greatest influence on the optimal strategy. INTERPRETATION: Countries should establish their own WTP threshold and consider routine TCV introduction, including a catch-up campaign when vaccination is optimal on the basis of this threshold. Obtaining improved estimates of the probability of hospital admission would be valuable whenever the optimal strategy is uncertain. FUNDING: Bill & Melinda Gates Foundation, Research Foundation-Flanders, and the Belgian-American Education Foundation. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/31130329/Cost_effectiveness_of_routine_and_campaign_use_of_typhoid_Vi_conjugate_vaccine_in_Gavi_eligible_countries:_a_modelling_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(18)30804-1 DB - PRIME DP - Unbound Medicine ER -