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Vaccine. 2017 Jun 14;35(27):3506-3514. doi: 10.1016/j.vaccine.2017.05.001. Epub 2017 May 17.

Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings.

Author information

1
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA. Electronic address: marina.antillon@yale.edu.
2
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.
3
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520-8034, USA.
4
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA. Electronic address: virginia.pitzer@yale.edu.

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.

KEYWORDS:

Conjugate vaccines; Cost-effectiveness studies; Low- and middle-income countries; Typhoid

PMID:
28527687
PMCID:
PMC5462484
DOI:
10.1016/j.vaccine.2017.05.001
[Indexed for MEDLINE]
Free PMC Article

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