VoICE Immunization Evidence: Cost effectiveness
An analysis of the impact of rotavirus vaccine in 25 Gavi countries found that the rates of vaccination in all countries were highest, and risk mortality lowest, in the top two wealth quintiles’ coverage. Countries differed in the relative inequities in these two underlying variables. Cost per DALYs averted is substantially greater in the higher quintiles. In all countries, the greatest potential vaccine benefit was in the poorest quintiles; however, reduced vaccination coverage lowered the projected vaccine benefit.
A study looking at the impact of pneumococcal vaccine introduction and scaling up pneumonia treatment in Ethiopia found that 30-40% of all deaths averted by these interventions would be expected to occur in the poorest wealth quintile. The greatest resulting financial risk protection would also be concentrated among the bottom income quintile.
A study of measles vaccine in Bangladesh found that children from the poorest quintile were more than twice as likely to die as those from the least quintile in the absence of measles vaccination. The difference in mortality between unvaccinated and vaccinated was statistically significant (p<0.10) and robust across alternative measures of socioeconomic status.
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.
The indirect benefit of immunization to unvaccinated individuals (herd immunity) increases the cost-effectiveness of vaccines.
The evidence on cholera disease dynamics suggests that significant herd protection can result from a relatively small number of immunizations, particularly in endemic areas where there is some natural immunity among the population.
This study based on active surveillance in the US before and after introduction of PCV estimated 38,000 cases of invasive pneumococcal disease were averted in the first 5 years of vaccine use, at an estimated cost of US$112,000 per life year saved. However, after inclusion of 71,000 cases of disease that were prevented through herd effects, researchers estimate a cost of US$7,500 per life year saved.
A multi-site study of cholera vaccination programs found that the vaccine was cost-effective in school- and community-based vaccination programs for children in India, Mozambique, and Indonesia.
PCV7 use in Argentina resulted in an estimated cost of US$5,599 per life year gained and the purchase of the 4 doses of vaccine for the entire cohort at a cost of US$26.5 dose would require an investment of US$73,823,806.
Assuming 90% coverage, a program in The Gambia using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1,000 DALYs over the first 5 years of life of a birth cohort. The estimated cost would be US$670 per DALY averted in The Gambia.
In Argentina, universal vaccination for Hepatitis A in children, at 95% vaccine coverage, can prevent over 350,000 hepatitis A infections per year and 428 deaths. Benefits persist at coverage rates as low as 70% with over 290,000 prevented infections. At 95% coverage rates, this program would save almost $24,000 annually.