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dc.contributor.authorBilcke, J.
dc.contributor.authorAntillón, M.
dc.contributor.authorPieters, Z.
dc.date.accessioned2019-09-13T14:49:31Z
dc.date.available2019-09-13T14:49:31Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85067871888&doi=10.1016%2fS1473-3099%2818%2930804-1&partnerID=40&md5=0f59efe1764f1d46409ea51afe1cbe3d
dc.identifier.urihttp://hdl.handle.net/10713/10589
dc.description.abstractBackground: Typhoid fever is a major cause of morbidity and mortality in low-income and middle-income countries. In 2017, WHO recommended the programmatic use of typhoid Vi-conjugate vaccine (TCV) in endemic settings, and Gavi, The Vaccine Alliance, has pledged support for vaccine introduction in these countries. Country-level health economic evaluations are now needed to inform decision-making. Methods: In this modelling study, we compared four strategies: no vaccination, routine immunisation at 9 months, and routine immunisation at 9 months with catch-up campaigns to either age 5 years or 15 years. For each of the 54 countries eligible for Gavi support, output from an age-structured transmission-dynamic model was combined with country-specific treatment and vaccine-related costs, treatment outcomes, and disability weights to estimate the reduction in typhoid burden, identify the strategy that maximised average net benefit (ie, the optimal strategy) across a range of country-specific willingness-to-pay (WTP) values, estimate and investigate the uncertainties surrounding our findings, and identify the epidemiological conditions under which vaccination is optimal. Findings: The optimal strategy was either no vaccination or TCV immunisation including a catch-up campaign. Routine vaccination with a catch-up campaign to 15 years of age was optimal in 38 countries, assuming a WTP value of at least US$200 per disability-adjusted life-year (DALY) averted, or assuming a WTP value of at least 25% of each country's gross domestic product (GDP) per capita per DALY averted, at a vaccine price of $1.50 per dose (but excluding Gavi's contribution according to each country's transition phase). This vaccination strategy was also optimal in 48 countries assuming a WTP of at least $500 per DALY averted, in 51 with assumed WTP values of at least $1000, in 47 countries assuming a WTP value of at least 50% of GDP per capita per DALY averted, and in 49 assuming a minimum of 100%. Vaccination was likely to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years. Uncertainty about the probability of hospital admission (and typhoid incidence and mortality) had the greatest influence on the optimal strategy. Interpretation: Countries should establish their own WTP threshold and consider routine TCV introduction, including a catch-up campaign when vaccination is optimal on the basis of this threshold. Obtaining improved estimates of the probability of hospital admission would be valuable whenever the optimal strategy is uncertain. Funding: Bill & Melinda Gates Foundation, Research Foundation-Flanders, and the Belgian-American Education Foundation. Copyright 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseen_US
dc.description.urihttps://doi.org/10.1016/S1473-3099(18)30804-1en_US
dc.language.isoen-USen_US
dc.publisherLancet Publishing Groupen_US
dc.relation.ispartofThe Lancet Infectious Diseases
dc.subjectlow-income countriesen_US
dc.subjectmiddle-income countriesen_US
dc.subjecttyphoid Vi-conjugate vaccineen_US
dc.subjectTCVen_US
dc.subject.meshTyphoid-Paratyphoid Vaccinesen_US
dc.subject.meshCost-Benefit Analysisen_US
dc.subject.meshGlobal Alliance for Vaccines and Immunizationen_US
dc.titleCost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/S1473-3099(18)30804-1
dc.identifier.pmid31130329


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