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Ibrahim AM, Owusu R, Nonvignon J. Sustainability of pneumococcal conjugate vaccination in Ghana: a cost-effectiveness analysis in the context of donor transition. Front Public Health 2024; 12:1383668. [PMID: 39148654 PMCID: PMC11324427 DOI: 10.3389/fpubh.2024.1383668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Background Streptococcus pneumonia is responsible for 18% of infant deaths in Ghana. With co-financing from Gavi in 2012, Ghana introduced the PCV13 into the childhood immunization programme to reduce the burden of Streptococcus pneumonia. However, Ghana will graduate to the Gavi fully self-financing phase in 2026, when the nation assumes full responsibility of paying for the PCV13. This research aims to evaluate the health impact and cost-effectiveness of PCV13 immunization in Ghana since its implementation and after the cessation of support from Gavi. Methods We used the UNIVAC tool to evaluate two main scenarios of cost-effectiveness, from vaccine introduction (2012-2025) and after Gavi transition (2026-2031) in comparison with no vaccination. The sources of data include national data, international estimates and expert opinion. Cost was considered from both the government and societal perspectives. We discounted health outcomes at 3%. Currency values were stated in US Dollars. We tested the robustness of the base case results by performing scenario and sensitivity analyses. Results PCV13 will reduce the pneumococcal disease burden by 48% from 2012 to 2031. The vaccination programme costs are USD 130 million and USD 275 million in 2012-2025 and 2026-2031 respectively. It also has a budget impact of USD 280 million for the 2026-2031 period from the perspective of government. The incremental cost-effectiveness ratios are USD 89 and USD 73 respectively from the perspectives of government and society in 2012-2025. The incremental cost-effectiveness ratios are USD 530 and USD 510 respectively from the perspectives of government and society in 2026-2031. Conclusion The PCV13 vaccination programme in Ghana is cost-effective at 50% GDP per capita threshold even when Gavi withdraws co-financing support from 2026 onwards.
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Affiliation(s)
| | - Richmond Owusu
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Evans-Gilbert T, Figueroa JP, Bonvehí P, Melgar M, Stecher D, Kfouri R, Munoz G, Bansie R, Valenzuela R, Verne E, Salas D, Jennifer Sanwogou N. Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean. Vaccine 2024; 42:2310-2316. [PMID: 38438288 DOI: 10.1016/j.vaccine.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
| | - J Peter Figueroa
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston, Jamaica.
| | - Pablo Bonvehí
- Center for Medical Education and Clinical Research, Av. Las Heras 2929, 1425 Buenos Aires, Argentina.
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala 01011, Guatemala.
| | - Daniel Stecher
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121 ABG Buenos Aires, Argentina.
| | - Renato Kfouri
- Immunization Department, Brasilian Society of Pediatrics, R. Santa Clara, 292 - Copacabana, Rio de Janeiro, RJ 22041-012, Brazil.
| | - Greta Munoz
- Hospital Pediátrico Baca Ortiz, S/N y D.M., Avenida 6 de Diciembre & Av. Cristóbal Colón, Quito, Ecuador.
| | - Rakesh Bansie
- Academic Hospital Paramaribo, RRP8+PQ7, Flustraat, Paramaribo, Suriname.
| | | | - Eduardo Verne
- Hospital Nacional Cayetano Heredia, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru.
| | - Daniel Salas
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
| | - N Jennifer Sanwogou
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
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Sume GE, Hasan Q, Shefer A, Henaff L, Cavallaro KF, Tencza CB, Hadler SC, Sidy N, Sardar P, Kagina BM, Hutin Y. Region-wide assessment of National Immunization Technical Advisory Groups (NITAGs) using the NITAG Maturity Assessment Tool (NMAT) - Experience from the Eastern Mediterranean Region of the World Health Organization, 2023. Vaccine 2024; 42:2239-2245. [PMID: 38413276 PMCID: PMC11007386 DOI: 10.1016/j.vaccine.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
National Immunization Technical Advisory Groups (NITAGs) are independent bodies that help improve national immunization programmes in decision making on immunization policy. The new NITAG Maturity Assessment Tool (NMAT) provided an opportunity to conduct a region-wide assessment to improve NITAG capacity and foster institutional growth. We share experience of the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) in using NMAT and the use of findings to develop improvement plans. NITAG chairs and secretariats from 22 EMR countries attended a virtual NMAT training in 2023. They self-assessed their NITAGs using the tool and developed improvement plans. An algorithm used the data to determine maturity levels for seven indicators. We consolidated results for the region by income groups. Of 22 countries (or NITAGs), 20 (91%) submitted NITAG assessment findings and 19 an improvement plan. The proportion of criteria met per indicator varied from 36% for independence and non-bias to 74% for establishment and composition. Maturity level varied by indicator. Of 20 NITAGs, less than half had an intermediate or higher-level maturity for the indicators of independence and non-bias 1 (5%), operations 3 (15%), making recommendations 4 (20%), stakeholder recognition 6 (30%), and resources and secretariat support 7 (35%). Meanwhile 11 (55%) NITAGs had an intermediate or higher maturity level for the indicators of establishment and composition and for integration into policy making process. Participants described NMAT as a concise, useful, user-friendly tool. NMAT is a practical tool that can be used by NITAGs to provide insights and strategic direction for individual countries and regionally. Prevention and management of conflict of interest is the domain that requires the most improvement in EMR. Planned activities should be implemented, monitored and a follow up assessment conducted in 2025.
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Affiliation(s)
- Gerald Etapelong Sume
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Universal Health Coverage Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt.
| | - Quamrul Hasan
- Immunization Vaccine Preventable Disease and Polio Transition Unit, Department of Universal Health Coverage Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt.
| | - Abigail Shefer
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Louise Henaff
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Headquarters, Geneva, Switzerland.
| | - Kathleen F Cavallaro
- Partnership for International Vaccine Initiatives, Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States.
| | | | - Stephen C Hadler
- Partnership for International Vaccine Initiatives, Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States.
| | - Ndiaye Sidy
- Vaccine Preventable Disease, Universal Health Coverage/Communicable and Non-communicable Disease Cluster, WHO Regional Office for Africa, Brazzaville, Congo.
| | - Parwiz Sardar
- Eastern Mediterranean Public Health Network, Amman, Jordan.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative (VACFA) and NITAG Support Hub (NISH), School of Public Health (SPH) and Institute of Infectious Diseases & Molecular Medicine (IDM), University of Cape Town (UCT), South Africa.
| | - Yvan Hutin
- Department of Universal Health Coverage Communicable Diseases, WHO Regional Office of the Eastern Mediterranean Region, Cairo, Egypt.
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Mahmud S, Baral R, Sanderson C, Pecenka C, Jit M, Li Y, Clark A. Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children: a decision-support model for use in low-income and middle-income countries. BMC Med 2023; 21:138. [PMID: 37038127 PMCID: PMC10088159 DOI: 10.1186/s12916-023-02827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young children. A number of mathematical models have been used to assess the cost-effectiveness of RSV prevention strategies, but these have not been designed for ease of use by multidisciplinary teams working in low-income and middle-income countries (LMICs). METHODS We describe the UNIVAC decision-support model (a proportionate outcomes static cohort model) and its approach to exploring the potential cost-effectiveness of two RSV prevention strategies: a single-dose maternal vaccine and a single-dose long-lasting monoclonal antibody (mAb) for infants. We identified model input parameters for 133 LMICs using evidence from the literature and selected national datasets. We calculated the potential cost-effectiveness of each RSV prevention strategy (compared to nothing and to each other) over the lifetimes of all children born in the year 2025 and compared our results to a separate model published by PATH. We ran sensitivity and scenario analyses to identify the inputs with the largest influence on the cost-effectiveness results. RESULTS Our illustrative results assuming base case input assumptions for maternal vaccination ($3.50 per dose, 69% efficacy, 6 months protection) and infant mAb ($3.50 per dose, 77% efficacy, 5 months protection) showed that both interventions were cost-saving compared to status quo in around one-third of 133 LMICs, and had a cost per DALY averted below 0.5 times the national GDP per capita in the remaining LMICs. UNIVAC generated similar results to a separate model published by PATH. Cost-effectiveness results were most sensitive to changes in the price, efficacy and duration of protection of each strategy, and the rate (and cost) of RSV hospital admissions. CONCLUSIONS Forthcoming RSV interventions (maternal vaccines and infant mAbs) are worth serious consideration in LMICs, but there is a good deal of uncertainty around several influential inputs, including intervention price, efficacy, and duration of protection. The UNIVAC decision-support model provides a framework for country teams to build consensus on data inputs, explore scenarios, and strengthen the local ownership and policy-relevance of results.
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Affiliation(s)
- Sarwat Mahmud
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Colin Sanderson
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
| | - You Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Andrew Clark
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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De Oliveira LH, Janusz CB, Da Costa MT, El Omeiri N, Bloem P, Lewis M, Luciani S. HPV vaccine introduction in the Americas: a decade of progress and lessons learned. Expert Rev Vaccines 2022; 21:1569-1580. [PMID: 36154390 DOI: 10.1080/14760584.2022.2125383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.
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Affiliation(s)
- Lucia H De Oliveira
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Cara B Janusz
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nathalie El Omeiri
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul Bloem
- Department of Immunizations, Biologicals, and Vaccines, World Health Organization, Geneva, Switzerland
| | - Merle Lewis
- Pan American Health Organization, Washington, DC, USA
| | - Silvana Luciani
- Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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6
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Ma C, Li J, Wang N, Wang Y, Song Y, Zeng X, Zheng C, An Z, Rodewald L, Yin Z. Prioritization of Vaccines for Inclusion into China’s Expanded Program on Immunization: Evidence from Experts’ Knowledge and Opinions. Vaccines (Basel) 2022; 10:vaccines10071010. [PMID: 35891174 PMCID: PMC9318118 DOI: 10.3390/vaccines10071010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Vaccine developers in China have made an increasing number of infectious diseases preventable through vaccination. An appropriate decision-making procedure is necessary for making wise decisions on whether to introduce new vaccines into the Expanded Program on Immunization (EPI). When there are several vaccines that could potentially be considered, a scientifically justifiable mechanism is needed for prioritizing and sequencing vaccines for consideration. Methods: We used a modified Delphi technique (MDT) to develop and refine an indicator system to prioritize vaccines and make policy recommendations concerning their introduction into China’s EPI system. From January through May 2021, thirty-nine experts were recruited and participated in a two-round Delphi survey that was based on a set of candidate indicators obtained through a literature review and reference to the WHO vaccine introduction recommendations. Using the resulting indicator system, we conducted a third consultation with a multi-disciplinary group of experts who scored five program-eligible candidate vaccines to determine prioritization and sequencing for consideration of inclusion into the EPI. Results: Response rates of the thirty-nine experts were 100% and 97.4% across the two rounds. Authority coefficients from rounds one to three were over 0.70, reflecting the high accuracy and reliability of the consultation. Coordination coefficients of importance scores for primary, secondary, and tertiary indicators were 0.486, 0.356, 0.275 in round one, and 0.405, 0.340, and 0.236 in round two. According to the scores from 30 experts using our indicator system, the sequence and scores (1–10 scale, 10 highest) of 5 candidate vaccines were varicella (6.91), meningococcal conjugate AC (6.83), Hib (6.74), influenza (6.56), and EV71 (6.17) vaccines. Conclusions: A modified Delphi technique effectively built a scientific, rational, comprehensive, and systematic indicator system for prioritizing vaccine candidates for consideration of inclusion into the EPI. The rank order will be used by the technical working groups of China’s National Immunization Advisory Committee to sequentially develop and present Evidence-to-Recommendation tables for making policy recommendations.
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Affiliation(s)
- Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Junhong Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Nan Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 201204, China;
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Yudan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Xiang Zeng
- Zhuhai Center for Disease Control and Prevention, Zhuhai 519000, China;
- Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Canjun Zheng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Lance Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
- Correspondence:
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7
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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8
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Steffen CA, Henaff L, Durupt A, Omeiri NE, Ndiaye S, Batmunkh N, Liyanage JBL, Hasan Q, Mosina L, Jones I, O'Brien K, Hombach J. Evidence-informed vaccination decision-making in countries: Progress, challenges and opportunities. Vaccine 2021; 39:2146-2152. [PMID: 33712350 DOI: 10.1016/j.vaccine.2021.02.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
Countries face an increasingly complex vaccination landscape. As well as ever-changing infectious disease epidemiology, the number and diversity of vaccine-preventable diseases, vaccine products, and vaccine technologies continue to increase. To ensure that vaccination decision-making is transparent, country-owned and informed by sound scientific evidence, many countries have established national immunization technical advisory groups (NITAGs) to provide independent expert advice. The past decade has seen substantial growth in NITAG numbers and functionality, and there is now a need to consolidate this progress, by further capacity building, to ensure that NITAGs are responsive to the changing face of immunization over the next decade.
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Affiliation(s)
- Christoph A Steffen
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Louise Henaff
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Antoine Durupt
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nathalie El Omeiri
- Pan-American Health Organization/Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | - Sidy Ndiaye
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Nyambat Batmunkh
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | | | - Quamrul Hasan
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Liudmila Mosina
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Ian Jones
- WHO Consultant, Jinja Publishing Ltd., Bishop's Stortford, UK
| | - Katherine O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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9
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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Pempa, Luz ACG, Luangasanatip N, Kingkaew P, Adhikari D, Isaranuwatchai W, Choiphel D, Pecenka C, Debellut F. Economic evaluation of rotavirus vaccination in children of Bhutan. Vaccine 2020; 38:5049-5059. [PMID: 32522415 PMCID: PMC7327517 DOI: 10.1016/j.vaccine.2020.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diarrhoea remains one of the top ten causes of under-five child morbidity in Bhutan, and rotavirus is a significant cause of child diarrhoeal hospitalisations. This study sought to determine the health outcomes, cost-effectiveness, and budget and human resource implications of introducing rotavirus vaccines in the routine immunisation program to inform Bhutan's decision-making process. METHODS We used UNIVAC model (version 1.3.41) to evaluate the cost-effectiveness of a rotavirus vaccination programme compared with no vaccination from a government perspective. We also projected the impact of rotavirus vaccination on human resources and budget. Acost-effectiveness threshold was determined to be 0.5 times the gross domestic product (GDP) per capita (equivalent to the United States dollar ($) 1,537) per Disability-Adjusted Life-Year (DALY) averted.One-way deterministic and probabilistic sensitivity analyses, and threshold analyses were performed to capture parameter uncertainties. RESULTS In Bhutan, a rotavirus vaccination programme over 10 years (2020 to 2029) can avert between 104 and 115 DALYs, at an incremental cost ranging from $322,000 to $1,332,000. The incremental cost-effectiveness ratio (ICER) across four vaccination programmes compared to no vaccination scenario were $9,267, $11,606, $3,201, and $2,803 per DALY averted for ROTARIX, RotaTeq, ROTAVAC, and ROTASIIL, respectively. The net five-year budget impact of introducing a rotavirus vaccination programme ranged from $0.20 to $0.81 million. The rotavirus vaccination programme has a potential to reduce the workload of health care workers such as paediatricians, nurses, dieticians, and pharmacists; however, the programme would require an additional 1.93-2.88 full-time equivalent of health assistants. CONCLUSION At the current cost-effectiveness threshold, routine rotavirus vaccination in Bhutan is unlikely to be cost-effective with any of the currently available vaccines. However, routine vaccination with ROTASIIL was under the cost-effectiveness threshold of one times the GDP per capita ($3,074). ROTASIIL and ROTAVAC would provide the best value for money in Bhutan.
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Affiliation(s)
- Pempa
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
| | - Alia Cynthia G Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand
| | - Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand.
| | - Deepika Adhikari
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Dechen Choiphel
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
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Castañeda-Orjuela C, García-Molina M, De la Hoz-Restrepo F. Is There Something Else Beyond Cost-Effectiveness Analysis for Public Health Decision Making? Value Health Reg Issues 2019; 23:1-5. [PMID: 31881441 DOI: 10.1016/j.vhri.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/13/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
Healthcare costs are a concern for the sustainability of health systems in both rich and poor countries. Achieving a balance between the aspirations of payers and the manufacturers of new technologies is a challenge for democratic societies. Evidence about the efficacy and effectiveness of a new intervention is a fundamental aspect for its inclusion, but additional information about organization, implementation, and feasibility is required. Economic evaluations, especially cost-effectiveness analyses (CEA), help inform the choice of a particular health intervention, but they are not the only input for decision making (DM). Use of CEA is relatively recent but has quickly become widespread. CEA techniques have evolved into increasingly complex and sophisticated methods intended to reflect reality closely but, at the same time, their results have become more difficult to verify and validate. In developed countries, CEA results have generated intense debates, but in developing countries, these reflections are still weak due to lack of technical capacity. Competing perspectives on CEAs exist and can heavily influence the DM process. The use of CEAs and the interpretation of their results requires critical analysis, especially when public funds are to be invested. Here, we present a perspective on the use of CEAs for DM that arises from our experience of its use in developing countries and requires the consideration of other rationalities, in addition to the economic one, for DM.
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Affiliation(s)
- Carlos Castañeda-Orjuela
- Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia; Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia.
| | | | - Fernando De la Hoz-Restrepo
- Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia
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Lee H, Park SY, Clark A, Debellut F, Pecenka C, Kim DS, Kim HM, Kim JH, Cho H, Kim AY, Lee M, Jung SY, Seong BL, Kang HY. Cost-effectiveness analysis of the implementation of a National Immunization Program for rotavirus vaccination in a country with a low rotavirus gastroenteritis-related mortality: A South Korean study. Vaccine 2019; 37:4987-4995. [DOI: 10.1016/j.vaccine.2019.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/08/2019] [Accepted: 07/05/2019] [Indexed: 01/10/2023]
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Anwari P, Debellut F, Pecenka C, Parwiz SM, Clark A, Groman D, Safi N. Potential impact and cost-effectiveness of rotavirus vaccination in Afghanistan. Vaccine 2018; 36:7769-7774. [PMID: 29107346 PMCID: PMC6290387 DOI: 10.1016/j.vaccine.2017.10.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/12/2017] [Accepted: 10/18/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite progress made in child survival in the past 20 years, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea. Rotavirus is responsible for more than a third of diarrhea deaths. In 2013, rotavirus was estimated to cause 215,000 deaths among children under five years, including 89,000 in Asia. As of April 2017, 92 countries worldwide have introduced rotavirus vaccination in their national immunization program. Afghanistan has applied for Gavi support to introduce rotavirus vaccination nationally. This study estimates the potential impact and cost-effectiveness of a national rotavirus immunization program in Afghanistan. METHODS This study examined the use of Rotarix® (RV1) administered using a two-dose schedule at 6 and 10 weeks of age. We used the ProVac Initiative's UNIVAC model (version 1.2.09) to evaluate the impact and cost-effectiveness of a rotavirus vaccine program compared with no vaccine over ten birth cohorts from 2017 to 2026 with a 3% annual discount rate. All monetary units are adjusted to 2017 US$. RESULTS Rotavirus vaccination in Afghanistan has the potential to avert more than one million cases; 660,000 outpatient visits; approximately 50,000 hospital admissions; 650,000 DALYs; and 12,000 deaths, over 10 years. Not accounting for any Gavi subsidy, rotavirus vaccination can avert DALYs at US$82/DALY from the government perspective and US$80/DALY from the societal perspective. With Gavi support, DALYs can be averted at US$29/DALY and US$31/DALY from the societal and government perspective, respectively. The average yearly cost of a rotavirus vaccination program would represent 2.8% of the total immunization budget expected in 2017 and 0.1% of total health expenditure. CONCLUSION The introduction of rotavirus vaccination would be highly cost-effective in Afghanistan, and even more so with a Gavi subsidy.
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Affiliation(s)
- Palwasha Anwari
- Afghanistan National Immunization Technical Advisory Group, District 10, Kabul, Afghanistan
| | | | - Clint Pecenka
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | - Sardar M Parwiz
- Expanded Program on Immunization, Directorate General of Preventive Medicine, Ministry of Public Health, District 1, Afghanistan
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Devin Groman
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | - Najibullah Safi
- Directorate General of Preventive Medicine, Ministry of Public Health, Masood Square, District 10, Kabul, Afghanistan
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Luciani S, Bruni L, Agurto I, Ruiz-Matus C. HPV vaccine implementation and monitoring in Latin America. SALUD PUBLICA DE MEXICO 2018; 60:683-692. [PMID: 30699273 DOI: 10.21149/9090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/08/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe HPV vaccine program implementation, monitoring and evaluation experiences in Latin America. MATERIALS AND METHODS We reviewed published articles in peer-reviewed journals and reports from government web- sites, as well as the PAHO/WHO/UNICEF Joint Reporting form and the ICO/IARC HPV Information Centre database. RESULTS By December 2016, 13 countries/territories in Latin America (56%) have introduced HPV vaccines. The majority have done so in the past three years, targeting 10- 12 year old girls with a two dose schedule, through school programs. Vaccine coverage ranges from 30 to 87%. Safety monitoring is well established, but monitoring vaccine impact is not, and data are not available. CONCLUSIONS . Although Latin America is the most advanced developing region with HPV vaccine introduction, systems for its monitoring are weak and there is a paucity of consistently available coverage data for this vaccine. Challenges remain to introduce HPV vaccines in several countries, to achieve high coverage, and to strengthen monitoring, evaluation and reporting.
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Affiliation(s)
- Silvana Luciani
- Unit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, USA
| | - Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology. Barcelona, Spain
| | - Irene Agurto
- Unit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, USA
| | - Cuauhtémoc Ruiz-Matus
- Unit of Comprehensive Family Immunization, Department of Family, Gender and Lifecourse, Pan American Health Organization. Washington, DC, USA
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Sarker AR, Sultana M, Mahumud RA, Van Der Meer R, Morton A. Cost-effectiveness analysis of introducing universal childhood rotavirus vaccination in Bangladesh. Hum Vaccin Immunother 2018; 14:189-198. [PMID: 29099653 PMCID: PMC5791570 DOI: 10.1080/21645515.2017.1356962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/21/2017] [Accepted: 07/14/2017] [Indexed: 10/18/2022] Open
Abstract
Diarrhea is one of the world's leading killers of children, and globally, rotavirus is the most common cause of severe diarrhea among under 5 children. In Bangladesh, rotavirus kills nearly 6,000 under 5 children in each year. To reduce the burden of childhood rotavirus diseases, universal rotavirus vaccination is recommended by World Health Organization. The objective of this study is to assess the cost-effectiveness of introducing universal childhood rotavirus vaccination with the newly developed ROTAVAC vaccine in national Expanded Programme of Immunization in Bangladesh. We developed a decision model to examine the potential impact of vaccination in Bangladesh and to examine the effect if the vaccination is applied in the nationwide immunization program schedule. Introduction of childhood universal rotavirus vaccination in Bangladesh scenario appears as highly cost-effective and would offer substantial future benefits for the young population if vaccinated today. The cost per DALY averted of introducing the rotavirus vaccine compared with status quo is approximately US$ 740.27 and US$ 728.67 per DALY averted from the health system and societal perspective respectively which is "very cost-effective" using GDP threshold level according to World Health Organization definition. The results of this analysis seek to contribute to an evidence-based recommendation about the introduction of universal rotavirus vaccination in national Expanded Programme of Immunization (EPI) in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems & Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
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Carvalho N, Jit M, Cox S, Yoong J, Hutubessy RCW. Capturing Budget Impact Considerations Within Economic Evaluations: A Systematic Review of Economic Evaluations of Rotavirus Vaccine in Low- and Middle-Income Countries and a Proposed Assessment Framework. PHARMACOECONOMICS 2018; 36:79-90. [PMID: 28905279 PMCID: PMC5775390 DOI: 10.1007/s40273-017-0569-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND In low- and middle-income countries, budget impact is an important criterion for funding new interventions, particularly for large public health investments such as new vaccines. However, budget impact analyses remain less frequently conducted and less well researched than cost-effectiveness analyses. OBJECTIVE The objective of this study was to fill the gap in research on budget impact analyses by assessing (1) the quality of stand-alone budget impact analyses, and (2) the feasibility of extending cost-effectiveness analyses to capture budget impact. METHODS We developed a budget impact analysis checklist and scoring system for budget impact analyses, which we then adapted for cost-effectiveness analyses, based on current International Society for Pharmacoeconomics and Outcomes Research Task Force recommendations. We applied both budget impact analysis and cost-effectiveness analysis checklists and scoring systems to examine the extent to which existing economic evaluations provide sufficient evidence about budget impact to enable decision making. We used rotavirus vaccination as an illustrative case in which low- and middle-income countries uptake has been limited despite demonstrated cost effectiveness. A systematic literature review was conducted to identify economic evaluations of rotavirus vaccine in low- and middle-income countries published between January 2000 and February 2017. We critically appraised the quality of budget impact analyses, and assessed the extension of cost-effectiveness analyses to provide useful budget impact information. RESULTS Six budget impact analyses and 60 cost-effectiveness analyses were identified. Budget impact analyses adhered to most International Society for Pharmacoeconomics and Outcomes Research recommendations, with key exceptions being provision of undiscounted financial streams for each budget period and model validation. Most cost-effectiveness analyses could not be extended to provide useful budget impact information; cost-effectiveness analyses also rarely presented undiscounted annual costs, or estimated financial streams during the first years of programme scale-up. CONCLUSIONS Cost-effectiveness analyses vastly outnumber budget impact analyses of rotavirus vaccination, despite both being critical for policy decision making. Straightforward changes to the presentation of cost-effectiveness analyses results could facilitate their adaptation into budget impact analyses.
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Affiliation(s)
- Natalie Carvalho
- Centre for Health Policy and Global Burden of Disease Group, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
| | - Sarah Cox
- Initiative for Vaccine Research, World Health Organization, Program in Applied Vaccine Experiences Scholar, Geneva, Switzerland
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore, Singapore
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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Tohme RA, Francois J, Cavallaro KF, Paluku G, Yalcouye I, Jackson E, Wright T, Adrien P, Katz MA, Hyde TB, Faye P, Kimanuka F, Dietz V, Vertefeuille J, Lowrance D, Dahl B, Patel R. Expansion of Vaccination Services and Strengthening Vaccine-Preventable Diseases Surveillance in Haiti, 2010-2016. Am J Trop Med Hyg 2017; 97:28-36. [PMID: 29064356 PMCID: PMC5676636 DOI: 10.4269/ajtmh.16-0802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Following the 2010 earthquake, Haiti was at heightened risk for vaccine-preventable diseases (VPDs) outbreaks due to the exacerbation of long-standing gaps in the vaccination program and subsequent risk of VPD importation from other countries. Therefore, partners supported the Haitian Ministry of Health and Population to improve vaccination services and VPD surveillance. During 2010–2016, three polio, measles, and rubella vaccination campaigns were implemented, achieving a coverage > 90% among children and maintaining Haiti free of those VPDs. Furthermore, Haiti is on course to eliminate maternal and neonatal tetanus, with 70% of communes achieving tetanus vaccine two-dose coverage > 80% among women of childbearing age. In addition, the vaccine cold chain storage capacity increased by 91% at the central level and 285% at the department level, enabling the introduction of three new vaccines (pentavalent, rotavirus, and pneumococcal conjugate vaccines) that could prevent an estimated 5,227 deaths annually. Haiti moved from the fourth worst performing country in the Americas in 2012 to the sixth best performing country in 2015 for adequate investigation of suspected measles/rubella cases. Sentinel surveillance sites for rotavirus diarrhea and meningococcal meningitis were established to estimate baseline rates of those diseases prior to vaccine introduction and to evaluate the impact of vaccination in the future. In conclusion, Haiti significantly improved vaccination services and VPD surveillance. However, high dependence on external funding and competing vaccination program priorities are potential threats to sustaining the improvements achieved thus far. Political commitment and favorable economic and legal environments are needed to maintain these gains.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeannot Francois
- Direction du Program Elargi de Vaccination (DPEV), Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Kathleen F Cavallaro
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilson Paluku
- Pan American Health Organization, Port-au-Prince, Haiti
| | | | | | - Tracie Wright
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Adrien
- Direction d'Épidémiologie, de Laboratoire et de Recherche (DELR), Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Mark A Katz
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pape Faye
- Pan American Health Organization, Port-au-Prince, Haiti
| | | | - Vance Dietz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Vertefeuille
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Lowrance
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Benjamin Dahl
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roopal Patel
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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Linares-Pérez N, Toledo-Romaní ME, Santana-Mederos D, García-Fariñas A, García-Rivera D, Valdés-Balbín Y, Vérez-Bencomo V. From individual to herd protection with pneumococcal vaccines: the contribution of the Cuban pneumococcal conjugate vaccine implementation strategy. Int J Infect Dis 2017; 60:98-102. [PMID: 28457742 DOI: 10.1016/j.ijid.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022] Open
Abstract
A new pneumococcal conjugate vaccine is currently undergoing advanced clinical evaluation prior to its planned introduction in Cuba. The implementation of the pneumococcal vaccination strategy has been designed with consideration of the need to maximize both its direct and indirect effects. A novel approach is suggested, which addresses preschool children as the first-line target group to generate herd immunity in infants and to have an impact on transmission at the community level. The clinical evaluation pipeline is described herein, including evaluations of effectiveness, cost-effectiveness, and impact. The scientific contribution of the Cuban strategy could support a paradigm shift from individual protection to a population effect based on a rigorous body of scientific evidence.
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Sartori AMC, Rozman LM, Decimoni TC, Leandro R, Novaes HMD, de Soárez PC. A systematic review of health economic evaluations of vaccines in Brazil. Hum Vaccin Immunother 2017; 13:1-12. [PMID: 28129026 DOI: 10.1080/21645515.2017.1282588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. OBJECTIVES To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. METHODS Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. RESULTS Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. CONCLUSIONS HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.
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Affiliation(s)
- Ana Marli Christovam Sartori
- a Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Luciana Martins Rozman
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Tassia Cristina Decimoni
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Roseli Leandro
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | | | - Patrícia Coelho de Soárez
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
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Glassman A, Cañón O, Silverman R. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:913-920. [PMID: 27987640 PMCID: PMC5193155 DOI: 10.1016/j.jval.2016.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. OBJECTIVE This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. RESULTS The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. METHODS We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. CONCLUSIONS Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future.
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de Oliveira LH, Trumbo SP, Ruiz Matus C, Sanwogou NJ, Toscano CM. Pneumococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned. Expert Rev Vaccines 2016; 15:1295-304. [PMID: 26982434 DOI: 10.1586/14760584.2016.1166961] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In Latin America and the Caribbean, pneumococcus has been estimated to cause 12,000-28,000 deaths, 182,000 hospitalizations, and 1.4 million clinic visits annually. Countries in the Americas have been among the first developing nations to introduce pneumococcal conjugate vaccines into their Expanded Programs on Immunization, with 34 countries and territories having introduced these vaccines as of September 2015. Lessons learned for successful vaccine introduction include the importance of coordination between political and technical decision makers, adjustments to the cold chain prior to vaccine introduction, and the need for detailed plans addressing the financial and technical sustainability of introduction. Though many questions on the Pneumococcal Conjugate Vaccine remain unanswered, the experience of the Americas suggests that the vaccines can be introduced quickly and effectively.
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Affiliation(s)
- Lucia Helena de Oliveira
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | | | - Cuauhtémoc Ruiz Matus
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | - N Jennifer Sanwogou
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | - Cristiana M Toscano
- c Department of Community Health, Institute of Tropical Pathology and Public Health , Federal University of Goiás , Goiânia , Brazil
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Andrus JK, Walker DG. Perspectives on expanding the evidence base to inform vaccine introduction: Program costing and cost-effectiveness analyses. Vaccine 2016; 33 Suppl 1:A2-3. [PMID: 25919161 DOI: 10.1016/j.vaccine.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jon Kim Andrus
- Sabin Vaccine Institute, 2000 Pennsylvania Avenue, NW Suite 7100, Washington, DC 20006, USA.
| | - Damian G Walker
- Bill and Melinda Gates Foundation, 500 Fifth Avenue, North Seattle, WA 98109, USA.
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