Cost-effectiveness and budget impact analysis of PPV23 vaccination for the Malaysian Hajj pilgrims

Abstract

The potential occurrence of disease outbreaks during the hajj season is of great concern due to extreme congestion in a confined space. This promotes the acquisition, spread and transmission of pathogenic microorganisms and pneumococcal disease are one of the most frequent infections among Hajj pilgrims. This study aimed to assess the cost-effectiveness and budget impact of introducing the PPV23 to Malaysian Hajj pilgrims. A decision tree framework with a 1-year cycle length was adapted to evaluate the cost-effectiveness of a PPV23 vaccination program with no vaccination. The cost information was retrieved from the Lembaga Tabung Haji Malaysia (LTH) database. Vaccine effectiveness was based on the locally published data and the disease incidence specifically related to Streptococcus pneumoniae was based on a literature search. Analyses were conducted from the perspective of the provider: Ministry of Health and LTH Malaysia. The incremental cost-effectiveness ratios (ICER), cases averted, and net cost savings were estimated. Findings from this study showed that PPV23 vaccination for Malaysian Hajj pilgrims was cost-effective. The PPV23 vaccination programme has an ICER of MYR -449.3 (US$-110.95) per case averted. Based on the national threshold value of US$6,200-US$8,900 per capita, the base-case result shows that introduction of the PPV23 vaccine for Malaysian Hajj pilgrims is very cost-effective. Sensitivity analysis revealed parameters related to annual incidence and hospitalised cost of septicemia and disease without vaccination as the key drivers of the model outputs. Compared with no vaccination, the inclusion of PPV23 vaccination for Malaysian Hajj pilgrims was projected to result in a net cost saving of MYR59.6 million and 109,996 cases averted over 5 years period. The PPV23 vaccination program could substantially offer additional benefits in reducing the pneumococcal disease burden and healthcare cost. This could be of help for policymakers to consider the implementation of PPV23 vaccination for Malaysian performing hajj.

Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

“…Lack of financial resources for the recommended influenza and pneumococcal vaccinations amongst pilgrims with asthma was a disincentive, leaving pilgrims at risk of influenza and Streptococcus pneumoniae infections 21 . A new mandatory vaccination policy for Malaysian pilgrims requires sufficient data on the burden of vaccine-preventable disease during Hajj and the cost-effectiveness 22 and the cost burden should be properly addressed by MOH and HFB. Primary care public-private partnership 23 and/or collaboration between MOH and HFB in the financing of resources such as the LABA/ICS inhalers and, pneumococcal and influenza vaccinations could be considered to address the resource constraint.…”