Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study
dc.contributor.author | Bilcke, J. | |
dc.contributor.author | Antillón, M. | |
dc.contributor.author | Pieters, Z. | |
dc.date.accessioned | 2019-09-13T14:49:31Z | |
dc.date.available | 2019-09-13T14:49:31Z | |
dc.date.issued | 2019 | |
dc.identifier.uri | https://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.uri | http://hdl.handle.net/10713/10589 | |
dc.description.abstract | Background: 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 license | en_US |
dc.description.uri | https://doi.org/10.1016/S1473-3099(18)30804-1 | en_US |
dc.language.iso | en-US | en_US |
dc.publisher | Lancet Publishing Group | en_US |
dc.relation.ispartof | The Lancet Infectious Diseases | |
dc.subject | low-income countries | en_US |
dc.subject | middle-income countries | en_US |
dc.subject | typhoid Vi-conjugate vaccine | en_US |
dc.subject | TCV | en_US |
dc.subject.mesh | Typhoid-Paratyphoid Vaccines | en_US |
dc.subject.mesh | Cost-Benefit Analysis | en_US |
dc.subject.mesh | Global Alliance for Vaccines and Immunization | en_US |
dc.title | Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study | en_US |
dc.type | Article | en_US |
dc.identifier.doi | 10.1016/S1473-3099(18)30804-1 | |
dc.identifier.pmid | 31130329 |