VoICE Immunization Evidence: Cost effectiveness

Key Concept

Key Evidence: Providing a birth dose of hepatitis B vaccine to all newborns (in addition to routine HepB immunization) was found to be a highly cost-effective means of preventing hepatitis B-related deaths in three refugee populations in Africa which are at extremely high risk of hepatitis B infection. Providing a birth dose only to newborns whose mothers test positive on a rapid diagnostic test was less cost-effective than vaccinating all newborns automatically. Thus, universal hepatitis B vaccination of newborns should remain a priority in refugee camps, despite competing humanitarian needs.

Reardon JM, O'Connor SM, Njau JD et al. 2019. Cost-effectiveness of birth-dose hepatitis B vaccination among refugee populations in the African region: a series of case studies. Conflict and Health. 13(5).

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Key Evidence: Children living in the Yida refugee camp in South Sudan in 2013 were found to have an elevated rate of pneumonia infections likely due to malnutrition, overcrowding, and inadequate shelter. Using these data, the CDC estimated that the use of Hib and pneumococcal vaccines in children under 2 years of age in the camp would be cost-effective under all dosing scenarios evaluated. Medecines Sans Frontiers (MSF) provided medical services to this refugee camp and found delivery of these vaccines to be feasible and effective in this setting.

Gargano L.M., Hajjeh R., and Cookson S.T. 2017. Pneumonia prevention: Cost-effectiveness analyses of two vaccines among refugee children aged under two years, Haemophilus influenzae type b-containing and pneumococcal conjugate vaccines, during a humanitarian emergency, Yida camp, South Sudan. Vaccine. 2017; 35(3): 435-441.

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Key Evidence: In a study of different strategies for preventing hepatitis B infections in newborns in a Burmese refugee population with a high infection rate, administering hepatitis B immune globulin to newborns whose mothers test positive through a rapid diagnostic test — in addition to vaccinating all newborns with a birth dose — prevented twice as many infections in newborns than vaccination alone and was cost-effective (while the current strategy of providing immune globulin only after a confirmatory lab test was done was not). Thus, this strategy could be considered for similar marginalized or poor populations.

Devine A, Harvey R, Min AM et al. 2017. Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis. BMC Infectious Diseases. 17(552).

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Key Evidence: A comprehensive review of the economics of cholera and cholera prevention concluded that vaccination using oral cholera vaccines can be cost-effective, especially when herd effects are taken into account and when vaccination is administered to populations and age groups with high incidence rates (e.g., children) and to areas with high cholera case fatality rates.

Hsiao A, Hall AH, Mogasale V et al. 2018. The health economics of cholera: a systematic review. Vaccine. 36(30).

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Key Evidence: A study using local epidemiological and economic data found that vaccinating children 1-14 years old in high-risk slum areas in Dhaka, Bangladesh using a locally-produced oral cholera vaccine provided through periodic campaigns would be a highly cost-effective means of controlling endemic cholera — reducing cholera incidence in the entire population by 45% over 10 years and costing US$440-635 per DALY averted. Vaccinating all persons aged one and above would reduce incidence much further (by 91%) but would be less cost-effective.

Khan IK, Levin A, Chai DL, DeRoeck D et al. 2018. The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: a disease modeling and economic analysis. PLoS NTD. 12(10).

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