Cost-Effectiveness of Haemophilus influenzae Type b Conjugate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assessment of Major Determinants

Abstract

Objectives To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low-and middle-income countries and identify the model variables, which are most important for the result. Study design A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. Results From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%–53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. Conclusions Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae.

Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries

“…This analysis revealed that the cost-effective vaccine price for an infant-targeted vaccine would be in a similar range to those prices charged for other vaccines (<$10) (28,29). Adolescent/adult-targeted vaccine could be priced at a higher level, but still less than the price of human papillomavirus vaccines (<$50) (30).…”

“…Our regression analysis method for approximating treatment and productivity costs in all study countries has been used in previous studies (27,28), and we consider these results to be relatively robust estimates despite heterogeneity between studies. Less evidence is available about vaccine delivery costs, particularly for mass campaigns, and we had to make relatively crude assumptions about this parameter.…”

“…We undertook a systematic literature review on mean TB treatment cost per patient and used a regression analysis to extrapolate these data to all study countries (27,28) (SI Appendix, Table S11). Productivity costs due to TB were estimated using the human capital method (40) by assuming a productivity loss of 2 mo or 6 mo for a case of TB or MDR-TB, respectively (41, 42) (SI Appendix, Table S14).…”

Budget impact analysis of vaccination against Haemophilus influenzae type b as a part of a Pentavalent vaccine in the childhood immunization schedule of Iran

“…The most important clinical manifestations of Hib are meningitis, pneumonia, and other non-meningitis-non-pneumonia (NMNP) diseases like septicemia, orbital cellulitis, septic arthritis, osteomyelitis, and sinusitis [4]. …”

Progress towards Demonstrating the Impact of Haemophilus influenzae Type b Conjugate Vaccines Globally

“…Griffiths et al identified key determinants that drive cost-effectiveness analysis for Hib vaccine, based on a user friendly model that makes it easier for countries to conduct such analysis. 13 The analysis from India 14 reveals the high cost-effectiveness of the vaccine, using various scenarios. Fortunately, and after a long delay, India has introduced Hib vaccine in late 2011 in 2 states and 6 additional states are planning to introduce the vaccine by the end of 2012.…”