Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

Dorji, Kinley; Phuntsho, Sonam; Pempa,; Kumluang, Suthasinee; Khuntha, Sarayuth; Kulpeng, Wantanee; Rajbhandari, Sneha; Teerawattananon, Yot

doi:10.1016/j.vaccine.2018.02.048

Cited by 22 publications

(27 citation statements)

References 37 publications

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“…The majority of the studies (n = 10) compared the potential benefits of two newer versions of PCV, namely PCV-10 and PCV-13 [20,25,28,31,34,36,37,42,44,47]. Seven studies assessed the cost-effectiveness of PCV-7 [27,29,30,32,33,39,46], of which one study assessed its effectiveness in the context of typical and pandemic influenza seasons [30].…”

Section: Methodsmentioning

confidence: 99%

“…PCV-13 was assessed in six studies [35,38,40,41,43,45] and comparisons of various types of vaccines were performed in two studies [26,48]. The majority of studies used quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as the health outcomes measure [20,25,26,32,[35][36][37][38][39][40][41]44,47,48] while the rest combined both the clinical and the utility outcomes or provided only clinical outcomes, e.g., cases of pneumococcal-related diseases and life years. Three studies performed both a CUA and a budget impact analysis (BIA) [31,37,45], while one study performed CEA and BIA [39].…”

Section: Methodsmentioning

confidence: 99%

“…The included studies were conducted in 11 Asian countries, including China (n = 7) [26,30,32,33,35,41,48] Malaysia (n = 3) [34,42,44], Hong Kong (n = 3) [28,29,42] Korea (n = 2) [25,46], The Philippines (n = 2) [31,36],Taiwan (n = 2) [27,43], Japan (n = 3) [20,38,39], Thailand (n = 1) [47], Mongolia (n = 1) [45], Bhutan (n = 1) [37], and India (n = 1) [40] (Table 1). One study was a multiple country analysis, performed in Malaysia and Hong Kong [42].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The oldest study that appeared from our search was from 2009, addressing the CEA of PCV-7 in Hong Kong [29], and the most recent one was from 2019, investigating the cost-effectiveness of PCV-13 in India [40]. At the time when the research was conducted, only three countries, i.e., Mongolia, Bhutan, and India [37,40,45], were eligible for discounted vaccine purchase prices offered through support from Gavi, The Vaccine Alliance, an organization established in 2000 to improve access to the vaccine for children in the world's poorest countries [49].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

et al. 2020

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Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

et al. 2020

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“…A health economics analysis was conducted to determine the cost-utility of 10-and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan [36]. It suggested that PCV13 and PCV10 could prevent 30 and 18 deaths respectively in the vaccinated population.…”

Section: National Preventive Strategiesmentioning

confidence: 99%

Pneumonia in Bhutanese children: what we know, and what we need to know

2020

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Background: Pneumonia is the single largest cause of death in under-five children worldwide. We conducted a systematic review to identify the knowledge gaps around childhood pneumonia in Bhutan. Methods: We searched PubMed, ScienceDirect and Google scholar from conception to 3rd December 2018, World Health Organization, UNICEF, Bhutan's Ministry of Health and other local databases for relevant reports. We included any report describing pneumonia in Bhutanese children with regards to the burden of the disease, aetiology, related risk factors, clinical and prognostic characteristics, surveillance systems and national preventive strategies. Two review authors identified the records. We summarized the findings narratively. Results: We included 44 records. Although with notable decreasing trends, pneumonia is still accountable for a high burden and mortality rate in Bhutanese children. The national surveillance system focuses mainly on influenza identification but has recently introduced other viral aetiology to monitor. We found very scarce or no data with regard to the bacterial aetiology, related risk factors and clinico-radiological and prognostic characteristics. Conclusion: There is a dearth of data regarding the epidemiological, microbiological, clinical and radiological characteristics of pneumonia in children in Bhutan, leading to challenges while implementing evidence-based management and effective national preventive strategies.

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Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies

Tshering,

Sharma,

Tshering

et al. 2024

Public Health Challenges

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Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

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Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

Abstract: HighlightsPCV13 and PCV10 are both cost-effective in Bhutan.PCV13 yields better health outcomes and slightly more cost than PCV10.Introducing PCV would reduce the workload of scarce medical specialists in Bhutan.

Cited by 22 publications

References 37 publications

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

Pneumonia in Bhutanese children: what we know, and what we need to know

Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies

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