Cost-Effectiveness Analysis of a Universal Infant Immunization Program with Meningococcal C Conjugate Vaccine in Brazil

Abstract

A universal childhood vaccination program against meningococcal C proved to be a cost-effective strategy, supporting the recent decision of the Brazilian government. These results could contribute to defining the most favorable price of the vaccine and to monitoring its impact on the population.

A systematic review of health economic evaluations of vaccines in Brazil

“…1), 20 were full HEEs that dealt with vaccines, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] all them published between 1995 and 2013. Figure 2 shows the growth in the number of HEEs on vaccines published in the period.…”

“…13,14,30 Indirect effects of the vaccination program (herd protection) was considered in 40% (8/ 20) of the reviewed studies: in 5 studies, which assessed HPV (2 studies), varicella, hepatitis A and dengue vaccination programs, 19,[26][27][28]32 the indirect effects were captured in the base case analysis by a dynamic model; and in 3 studies that assessed childhood pneumococcal conjugate vaccination using statistic decision tree model, the indirect protection was evaluated in a secondary or sensitivity analysis. [21][22][23] Six studies did not take indirect protection into account 14,17,18,24,25,29 and 6 did not inform. 13,15,16,20,30,31 Table 2 and Table 3 present the main methodological characteristics of the selected articles.…”

“…The most used types of HEE, according to the classification suggested by Drummond,8 were cost-effectiveness analysis (CEA, 45%), 17,[19][20][21][22]24,25,28,30 cost-utility analysis (CUA, 20%) 26,27,31,32 and both CEA and CUA performed simultaneously (15%). 18,23,29 Sixteen of the 20 articles (80%) were published in international journals; 5 in scientific journals specialized in vaccines, 4 in public health journals, 5 in infectious diseases journals.…”

“…Six studies (30%) were funded by the pharmaceutical industry, 14,18,[21][22][23][24] 6 (30%) by the government and research funding agencies, 17,19,25,[28][29][30] and 3 (15%) were financed by research institutes. 15,31,32 Conflict of interest was reported in 35% (7/20) of the studies; 5 articles reported having conflict of interest.…”

“…15 Thirteen studies (65%) presented the incremental HEE: health economic evaluation cost-effectiveness ratio (ICER). [17][18][19][21][22][23][24][25][26][27][28][29]31 One study presented the net benefit, 14 and another presented cost difference. 13 Based on WHO proposed criteria for cost-effectiveness to interpret the studies' results, 11 considering the 13 studies that reported ICERs, the vaccination strategy was cost-saving in 3 studies; the ICER was <1 per capita gross domestic product (GDP) per DALY, considered as very cost-effective, in 7 studies; and the ICER was between 1 and 3 GDP/DALY, considered cost-effective, in 3 studies.…”