Cost effectiveness of typhoid vaccination in India

Abstract

Introduction World Health Organization has prequalified the use of typhoid conjugate vaccine (TCV) in children over six months of age in typhoid endemic countries. We assessed the cost-effectiveness of introducing TCV separately for urban and rural areas of India. Methods A decision analytic model was developed, using a societal perspective, to compare long-term costs and outcomes (3% discount rate) in a new-born cohort of 100,000 children immunized with or without TCV. Three vaccination scenarios were modelled, assuming the protective efficacy of TCV to last for 5, 10 and 15 years following immunization. Incidence of typhoid infection estimated under ‘National Surveillance System for Enteric Fever’ (NSSEFI)’ was used. The prices of vaccine and cost of service delivery were included for vaccination arm. Both health system cost and out-of-pocket expenditures for treatment of typhoid illness and its complications was included. Results TCV introduction in urban areas would result in prevention of 17% to 36% typhoid cases and deaths. With exclusion of indirect costs, the incremental cost per QALY gained was ₹ 151,346 (54,730–307,975), ₹ 61,710 (−5250 to 163,283) and ₹ 45,188 (−17,069 to 141,093) for scenario 1, 2 and 3 respectively. While, with inclusion of indirect costs, all 3 scenarios were cost saving. Further, in rural areas, TCV is estimated to reduce the typhoid cases and deaths by 19% to 36%, with ICER (incremental cost per QALY gained) ranging from ₹ 2340 (1316–4370) to ₹ 3574 (2057 – 6691) thousand (inclusive of indirect costs) among the 3 vaccination scenarios. Conclusion From a societal perspective, introduction of TCV is a cost saving strategy in urban India. Further, due to low incidence of typhoid infection, introduction of TCV is not cost-effective in rural settings of India.

Cost-effectiveness and public health impact of typhoid conjugate vaccine introduction strategies in Bangladesh

“…For example, in the status quo analysis, we projected that children and Dhaka will be disproportionately affected. Our findings were also broadly consistent with past studies that have projected that typhoid conjugate vaccination can be cost effective and even cost saving in typhoid endemic areas [19] , [21] , [41] , [42] , [43] , [44] . A major constraint for past country-level cost-effectiveness analyses has been a paucity of incidence data, particularly outside of selected urban settings where typhoid surveillance studies have been conducted.…”

Comparison of model predictions of typhoid conjugate vaccine public health impact and cost-effectiveness

“…They also found that vaccination was more cost-effective in urban areas, which tend to have higher incidence. Chauhan et al (2021) used a static decision-analytic model, most similar to Model C in our study, to predict the cost-effectiveness of TCV introduction over a 15-year period [49] . Testing a routine vaccination strategy at a WTP threshold of around $1900 USD (the threshold used in our study), they predicted that TCV use in urban settings would be cost-effective when indirect costs were excluded (similar to our study) and cost-saving when indirect costs were included (i.e., from a societal perspective).…”

Fraud analytics practices in public-sector transactions: a systematic review

“…The discussions included economic analysis of vaccination programs, cost analysis of patient surgery, correlation analysis of health investment and fiscal consequences, tax compliance modeling for digital economy, business process management systems, methods for understanding daily work practices, spending analysis, evaluating infrastructure financing, measuring financial performance efficiency, analyzing spending reductions, and comparative analyses of the financial performance of several city centers, and others (Agboola et al. , 2018; Antonelli and De Bonis, 2019; Chauhan et al. , 2021; Chernick et al.…”

“…Twenty-eight articles investigated the development of effectiveness and efficiency of business processes and financial management systems. The discussions included economic analysis of vaccination programs, cost analysis of patient surgery, correlation analysis of Fraud analytics practices health investment and fiscal consequences, tax compliance modeling for digital economy, business process management systems, methods for understanding daily work practices, spending analysis, evaluating infrastructure financing, measuring financial performance efficiency, analyzing spending reductions, and comparative analyses of the financial performance of several city centers, and others (Agboola et al, 2018;Antonelli and De Bonis, 2019;Chauhan et al, 2021;Chernick et al, 2015;Connolly et al, 2017;Dimitropoulou et al, 2018;Ghahari et al, 2021;Grundy et al, 2020;Guo et al, 2020;Haryanta et al, 2020;Henn et al, 2016;Hunt and Link, 2020;Kandel et al, 2012;Karlsson, 2020;Loukis et al, 2020;Mauskopf et al, 2018;Paul et al, 2021;Rabar et al, 2020;Sakr et al, 2018;Schubert, 2014;Sheetz et al, 2013;Taloba et al, 2022;Titus, 2020;Wahab and Bakar, 2021;Wang and Wang, 2014;Wang and Jin, 2019;Yang, 2021).…”