Cost-effectiveness and Financial Consequences of New Vaccine Introduction in Pakistan

Brenzel, Logan ; Sanderson, Colin ; Galayda, Victor ; Masud, Tayyeb ; Haq, Inaaml ul

World Bank, Washington, DC

关键词: ACUTE RESPIRATORY INFECTION;    AGED;    ANTIGENS;    BACTERIAL INFECTIONS;    BCG;   

RP-ID  :  65830

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Pakistan has one of the highest infant mortalityrates in the world, and over 50 percent of deaths inpost-neonatal children are attributable to pneumonia,diarrhea, or meningitis diseases that can be preventedthrough vaccination. The purpose of the study is to comparethe cost-effectiveness and financial implications ofintroducing pneumococcal (PCV-10), rotavirus (Rota-Teq), andHomophiles influenza type B (Hib) vaccines in Pakistan. Thecost-effectiveness analysis was conducted using the Tri-Vacmodel, which is a static model that estimates the burden ofdisease and the costs of treatment and for the immunizationprogram of children up to five years old in ten annual birthcohorts (2010 to 2019). Sensitivity analyses were conductedtesting key assumptions related to disease burden, vaccineefficacy, and vaccine cost. The analysis of financialimplications included a projection of cold chain needs andcosts associated with the introduction of each new vaccine,as well as the financial outlays required by the government.Sensitivity testing was also conducted on major assumptions.All three vaccines were found to be cost-effective, with Hibvaccine the most cost-effective option at $22 perdisability-adjusted-life-year (DALY). The cost-effectivenessfigures for PCV and rotavirus vaccines were $225/DALY and$201/DALY, respectively. Sensitivity testing did notsignificantly alter the results. The combined financialrequirement for the three new vaccines would peak in 2017 ifGAVI assistance reduced to five rather than eight years($213m). This cost would account for 40 percent of nationalimmunization expenditures, and 15 percent of governmenthealth expenditures. Required cold chain investments wouldbe small relative to the expenditure on vaccines, andrepresents a good return on investment. While the investmentwould be worthwhile from an economic perspective,introducing all three vaccines in Pakistan will presentfinancial challenges unless overall health spendingincreases. Careful consideration needs to be given tolong-term financing after GAVI support ends.