Economic evaluation of pneumococcal conjugate vaccination in The Gambia

BMC Infectious Diseases

Research Article

Sun-Young Kim¹  Gene Lee¹  Sue J Goldie² 

[1] Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA;Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA;Harvard Initiative for Global Health, Cambridge, MA, USA;

关键词: Vaccine Efficacy;    Invasive Pneumococcal Disease;    Pneumococcal Disease;    Pneumococcal Meningitis;    Herd Immunity;   

DOI  :  10.1186/1471-2334-10-260

 received in 2010-01-30, accepted in 2010-09-03,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundGambia is the second GAVI support-eligible country to introduce the 7-valent pneumococcal conjugate vaccine (PCV7), but a country-specific cost-effectiveness analysis of the vaccine is not available. Our objective was to assess the potential impact of PCVs of different valences in The Gambia.MethodsWe synthesized the best available epidemiological and cost data using a state-transition model to simulate the natural histories of various pneumococcal diseases. For the base-case, we estimated incremental cost (in 2005 US dollars) per disability-adjusted life year (DALY) averted under routine vaccination using PCV9 compared to no vaccination. We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination. To explore parameter uncertainty, we performed both deterministic and probabilistic sensitivity analyses. We also explored the impact of vaccine efficacy waning, herd immunity, and serotype replacement, as a part of the uncertainty analyses, by assuming alternative scenarios and extrapolating empirical results from different settings.ResultsAssuming 90% coverage, a program using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs, over the first 5 years of life of a birth cohort. Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost $670 per DALY averted in The Gambia. The corresponding values for PCV7, PCV10, and PCV13 were $910, $670, and $570 per DALY averted, respectively. Sensitivity analyses that explored the implications of the uncertain key parameters showed that model outcomes were most sensitive to vaccine price per dose, discount rate, case-fatality rate of primary endpoint pneumonia, and vaccine efficacy against primary endpoint pneumonia.ConclusionsBased on the information available now, infant PCV vaccination would be expected to reduce pneumococcal diseases caused by S. pneumoniae in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of $3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.

【 授权许可】

CC BY   
© Kim et al; licensee BioMed Central Ltd. 2010