An economic evaluation of the current measles vaccination program: A case study in Zhejiang Province, east China

Measles vaccination of young infants in China: A cost-effectiveness analysis

BACKGROUND

Although global progress in measles control has been realized, achieving elimination has proven difficult in many regions of the world. China has adopted a goal of measles elimination but recent outbreaks predominantly affecting children <8 months who are ineligible for vaccination and incompletely protected by maternal antibodies has impeded progress. We assess the cost-effectiveness of adding an initial measles vaccine dose in China to earlier than the currently recommended 8 months of age.

METHODS

We conducted a cost-utility analysis comparing the costs and health benefits associated with adding a measles vaccine dose to the routine schedule at 4, 5, 6 or 7 months compared to the current recommendation for the first dose at age 8 months. A decision analytic model was developed in Microsoft Excel, including five non-severe and two fatal health outcomes associated with measles infection. Model parameters were informed by the literature and surveillance data. Future costs and health benefits were discounted at 3%. Primary outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime time horizon.

RESULTS

Lowering the recommended age for initiating the measles vaccination series to address susceptibility in children <8 months provided incremental health gains compared to minimal costs at the individual-level. The ICER was most favorable ($232.70 per QALY gain) for administering an initial dose at 4 months of age due to fewer incremental program costs when shifting measles administration to an immunization visit already established under the Chinese vaccination program.

CONCLUSION

We found potential beneficial health gains at a minimum cost associated with adding an earlier measles dose <8 months of age in China. Further investigation about disease transmission dynamics is required to more fully assess the tradeoffs of administering measles at a younger age to infants in China.

Epidemiology and features of the measles course in children during the outbreak of 2018–2019 in the city of Mariupol

In 2017, Ukraine ranked in the top three among European countries in terms of measles incidence, and ranked first in measles growth in 2018. High morbidity, mortality and development of complications make the problem of knowing features of the measles clinical course, timely diagnosis and active prevention highly relevant. The purpose of the research is to study the dynamics of the incidence and clinical features of measles in children during the outbreak of 2018–2019 in the city of Mariupol, Donetsk region. A peculiarity of the measles outbreak in 2018–2019 in Mariupol is prevalence of the disease in preschool children (60.4%), inclu­ding 30.2% – those under one year of age; low vaccination rate: 52.3% of children unvaccinated; only 22.2% of children were vaccinated twice, according to the schedule. In all age groups, a moderately severe measles course prevailed (69.8%). The clinical course of measles in preschool and school age children had definitive features. Thus, Belsky–Filatov–Koplik spots were observed three times more frequently in preschool children than in schoolchildren (63.9% and 23.3%, respectively). Abdominal pain and diarrhea were only observed in children under 6 years of age (30.2%). Skin pigmentation was absent in children under one year of age and was detected in preschool and school-age children (69.8%). Skin sloughing was only observed in schoolchildren (10.4%). Severe disease course occurred in patients of all ages (29.3%), but children aged under one year and preschool children with severe disease were two times more numerous than those of the school age. Among the observed complications, the vast majority were associated with the respiratory organs: pneumonia (38.3%), subcutaneous emphysema (1.7%), bronchitis (53.2%), laryngitis (3.3%), otitis media (5%). No fatalities were observed. The city should form a commitment to immunization, restore public trust in vaccination, using all forms and means of information, and develop a program to implement the vaccination schedule into practice.

Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobulin treatment: a case study in Zhejiang Province, East China

Objective: To evaluate the cost-effectiveness of the current strategy combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for infants of hepatitis B surface antigen (HBsAg) positive mothers compared with universal vaccination with hepatitis B vaccine only.Methods: A decision tree model with a Markov process was constructed and used to simulate the lifetime of the birth cohort in Zhejiang Province during 2016. The current strategy was compared against universal vaccination with respect to costs and health effects. Costs were assessed from the health care system perspective. Health effects were measured by the number of hepatitis B virus (HBV) related diseases and deaths avoided and quality-adjusted life-years (QALYs) gained. The incremental cost‑effectiveness ratio (ICER) is calculated and compared to standard willingness-to-pay thresholds. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess parameter uncertainties.Results: Over the cohort's lifetime, 182 acute symptomatic infections, 2215 chronic infections, 872 cases of cirrhosis, 595 cases of hepatocellular carcinoma (HCC) and 1,350 HBV-related deaths among the cohort of 624,000 infants would be further avoided by the current strategy compared to universal vaccination. Universal vaccination was dominated by the current strategy that produced not only higher total QALYs, but also had lower costs. The results remained robust over a wide range of assumptions.Conclusions: The current strategy was cost saving compared to universal vaccination, and continuing the current strategy is recommended to further decrease the burden of hepatitis B.