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Li J, Chen S, Asturias E, Tang S, Cui F. Promoting higher-valent pediatric combination vaccines in China: challenges and recommendations for action. Infect Dis Poverty 2024; 13:12. [PMID: 38297394 PMCID: PMC10832179 DOI: 10.1186/s40249-024-01181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
Many countries have adopted higher-valent pediatric combination vaccines to simplify vaccination schedules and minimize health expenditures and social costs. However, China is conservative in the use of pediatric combination vaccines. By reviewing and synthesizing quantitative and qualitative data, in this commentary we identify gaps and challenges to combination vaccine use and make recommendations for promoting use of higher-valent pediatric combination vaccines in China. Challenges are in four dimensions: (1) legislation and regulation, (2) immunization schedule design, (3) vaccine awareness and price, and (4) research and development capacity. To optimize the use of combination vaccines to reduce vaccine-preventable disease burden, we make recommendations that address key challenges: (1) develop policies and regulations to strengthen enforcement of the Vaccine Administration Law and remove regulatory hurdles that hinder combination vaccine research and development, (2) establish an evidence-informed policy-making mechanism for combination vaccines, (3) resolve immunization schedule conflicts between monovalent and combination vaccines, and (4) implement effective interventions to increase vaccine awareness and reduce price.
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Affiliation(s)
- Jiuling Li
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
| | - Shu Chen
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia
- School of Risk and Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Edwin Asturias
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
- SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
- Vaccine Research Center, School of Public Health, Peking University, Beijing, China
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Olivera I, Pérez CG, Lazarov L, Lopez E, Oddo C, Dibarboure H. Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Serv Res 2023; 23:1067. [PMID: 37803345 PMCID: PMC10557326 DOI: 10.1186/s12913-023-10038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Argentina currently uses a pentavalent vaccine containing diphtheria, tetanus, pertussis (whole cell), Haemophilus influenza type b and hepatitis B antigens, administered concomitantly with the inactivated polio vaccine (IPV) (DTwP-Hib-HB plus IPV) in its childhood vaccination schedule. However, hexavalent vaccines containing acellular pertussis antigens (DTaP-Hib-HB-IPV) and providing protection against the same diseases are also licensed, but are only available with a private prescription or for high-risk pre-term infants in the public health program. We analyzed the cost of switching from the current schedule to the alternative schedule with the hexavalent vaccine in Argentina, assuming similar levels of effectiveness. METHODS The study population was infants ≤ 1 year of age born in Argentina from 2015 to 2019. The analysis considered adverse events, programmatic, logistic, and vaccine costs of both schemes from the societal perspective. The societal costs were disaggregated to summarize costs incurred in the public sector and with vaccination pre-term infants in the public sector. Costs were expressed in 2021 US Dollars (US$). RESULTS Although the cost of vaccines with the alternative scheme would be US$39.8 million (M) more than with the current scheme, these additional costs are in large part offset by fewer adverse event-associated costs and lower programmatic costs such that the overall cost of the alternative scheme would only be an additional US$3.6 M from the societal perspective. The additional cost associated with switching to the alternative scheme in the public sector and with the vaccination of pre-term infants in the public sector would be US$2.1 M and US$84,023, respectively. CONCLUSIONS The switch to an alternative scheme with the hexavalent vaccine in Argentina would result in marginally higher vaccine costs, which are mostly offset by the lower costs associated with improved logistics, fewer separate vaccines, and a reduction in adverse events.
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Affiliation(s)
- Ignacio Olivera
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Carlos Grau Pérez
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Luis Lazarov
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Eduardo Lopez
- Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
| | - Cristian Oddo
- Sanofi Vaccines, Buenos Aires, Argentina.
- , Cuyo 3512, Martinez, Buenos Aires, B1640GIY, Argentina.
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Min S, Kwon SH, Lee YW, Lee JM, Bae EJ, Lee EK. Estimating the Total Societal Cost of a Hexavalent Vaccine versus a Pentavalent Vaccine with Hepatitis B in South Korea. Vaccines (Basel) 2023; 11:vaccines11050984. [PMID: 37243088 DOI: 10.3390/vaccines11050984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
In South Korea, the ready-to-use hexavalent vaccine (against diphtheria, tetanus, pertussis, poliovirus, Haemophilus influenzae type b, and hepatitis B) is not listed despite its facility of no need to reconstitute. It, therefore, has the potential to augment the efficiency of prevention against the six infectious diseases, and it may reduce vaccine-related errors of reconstitution when compared with the currently used vaccination scheme of the pentavalent vaccine with the additional shots against hepatitis B. Given the assumed clinical equivalence between the two vaccination schemes, a cost-minimization analysis has been performed from a societal perspective including all the medical and non-medical direct and indirect costs when vaccinating one birth cohort. The results indicate that the ready-to-use hexavalent vaccine induces a cost reduction of KRW 47,155 (USD36.22) per infant or 12,026 million Korean Won ($9,236,417) in total for the whole birth cohort with 260,500 children. Using the ready-to-use hexavalent vaccine causes a lower infection rate, has fewer vaccination sessions, and may save much time as compared with the current vaccination scheme in place. The ready-to-use hexavalent vaccine may, therefore, benefit the National Immunization Program by reducing the total societal costs of vaccination while improving convenience of infants, parents, and medical care professionals.
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Affiliation(s)
- Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Yeon-Woo Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Jung-Min Lee
- Sanofi Korea Co., Ltd., Seoul 06578, Republic of Korea
| | - Eun Jin Bae
- Sanofi Korea Co., Ltd., Seoul 06578, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
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Boisnard F, Manson C, Serradell L, Macina D. DTaP-IPV-HB-Hib vaccine (Hexaxim): an update 10 years after first licensure. Expert Rev Vaccines 2023; 22:1196-1213. [PMID: 37936265 DOI: 10.1080/14760584.2023.2280236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Hexaxim® is fully liquid, hexavalent, combination vaccine that provides immunization against diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B, and invasive diseases caused by Haemophilus influenzae type b. Combination vaccines such as Hexaxim reduce the number of injections needed, improving both vaccination compliance and operational efficiency. AREAS COVERED Safety and immunogenicity data were reviewed from >25 clinical trials involving approximately 7200 infants/toddlers, identified using PubMed searches to April 2023. These trials have evaluated a diverse range of primary series and booster schedules, including antibody persistence, co-administration of Hexaxim with other routine pediatric vaccines, and specific populations (born to Tdap-vaccinated women, preterm, and immunocompromised infants). Lastly, post-marketing surveillance and real-world effectiveness data were assessed. EXPERT OPINION An extensive program of clinical development prior to licensure demonstrated favorable vaccine safety and good immunogenicity of each antigen, and Hexaxim was first approved for use in 2012. In the 10 years since licensure, Hexaxim has been adopted widely, with more than 180 million doses distributed worldwide. The widespread use of this hexavalent vaccine is a crucial tool in the ongoing and future control of six pediatric infectious diseases globally.
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Avila Agüero ML, Castillo JBD, Falleiros-Arlant LH, Berezín E, de Moraes JC, Torres-Martínez C, Lopez EL, Castillo ME, Laris-Gonzalez A, Solorzano F, Gentile A, Torres Torretti JP, López-Medina E. Risks of low vaccination coverage and strategies to prevent the resurgence of vaccine-preventable diseases in infants in the COVID-19 pandemic scenario: recommendations for Latin America and the Caribbean by the group of experts on infant immunization for Latin America. Expert Rev Vaccines 2023; 22:1091-1101. [PMID: 37843489 DOI: 10.1080/14760584.2023.2271057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The WHO 2030 Immunization Agenda (IA-2030) harmonizes immunization activity plans at community, national, regional and global levels. Additionally, medical societies play an important role. The Latin American Group of Experts on Infant Immunization, established in 2018, advises on the harmonization, update, and optimization of infant vaccination programs in Latin America and the Caribbean (LAC). In September 2021, 41 such experts from 13 LAC countries met to develop recommendations for increasing regional vaccination coverage to avoid the reemergence of vaccine-preventable diseases and/or the occurrence of outbreaks. AREAS COVERED The following items were evaluated: (i) immunization challenges before and during the COVID-19 pandemic; (ii) the status of current immunization programs, particularly infant pertussis and polio vaccination; (iii) possible solutions for overcoming vaccination challenges and achieving regional vaccination coverage targets. EXPERT OPINION/COMMENTARY Medical societies provide valuable recommendations to guide and update vaccination schedules. In the LAC region, possible strategies to achieve target vaccination rates include the use of combination vaccines, strengthening surveillance systems, improving school attendance, advancing vaccine education and confidence, striving for vaccination equity, widening operational capacity, creating strategic alliances, and strengthening the role of medical groups. It is hoped that these recommendations will be implemented in the LAC region.
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Affiliation(s)
- Maria L Avila Agüero
- Servicio de Infectología, Pediatra Infectóloga Hospital Nacional de Niños, San José, Costa Rica
- Center for Modeling and Analysis of Infectious Diseases (CIDMA), Yale University, New Haven, Connecticut, CT, USA
| | - Jose Brea Del Castillo
- Escuela de Medicina, Facultad de Ciencias de la Salud del Instituto Tecnológico de Santo Domingo, Santo Domingo, Dominican Republic
| | - Luiza Helena Falleiros-Arlant
- Departamento de Salud del Nino de la Facultad de Medicina de la Universidad Metropolitana de Santos, Sao Paulo, Brazil
| | - Eitan Berezín
- Departamento Saúde Coletiva Faculdade de Ciências Médicas Santa Casa, São Paulo, Brazil
| | - Jose Cassio de Moraes
- Departamento Saúde Coletiva Faculdade de Ciências Médicas Santa Casa, São Paulo, Brazil
| | | | - Eduardo L Lopez
- Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
- Facultad de Medicina, Universidad de Buenos Aires, Argentina
- DGO de Medicina, Hospital de NIños Ricardo Gutierrez, Buenos Aires, Argentina
| | - María E Castillo
- Pediatra Infectologa de la Oficina de Epidemiología del Instituto Nacional de Salud del Niño -Breña, Docente de la Facultad de Medicina de la Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Almudena Laris-Gonzalez
- Departamento de Infectología del Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Fortino Solorzano
- Departamento de Infectología del Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Angela Gentile
- Departamento de Epidemiología - Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Juan Pablo Torres Torretti
- Departamento de Pediatría, Hospital Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle, Cali, Colombia
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Liu B, Cao B, Wang C, Sun T, Miao Y, Zhang S, Zhao T, Cui F. Cost-minimization analysis of DTaP-IPV-Hib combination vaccine in China: A nationwide cross-sectional study. J Med Virol 2023; 95:e28358. [PMID: 36448181 DOI: 10.1002/jmv.28358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
Combination vaccines can reduce the vaccination visit, simplify the vaccination schedule and efficiently improve management. This study was primarily designed to evaluate the economic impact of integrating the diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine into the China National Immunization Program. A cost-minimization analysis (CMA) compared the costs associated with direct medical, direct nonmedical, and indirect social costs in four schemes was conducted. A budgetary impact analysis assessed the alternative schemes' financial impact on the healthcare budget. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct nonmedical (cost for transportation) and indirect costs (loss of productivity) were derived from parents' questionnaires. Replacement of the current vaccination scheme with DTaP-IPV-Hib combination vaccine, resulted in net increases in direct medical costs of 77.64% for alternative scheme 1, 146.54% for alternative scheme 2, and 294.67% for alternative scheme 3, respectively. However, the direct nonmedical and indirect costs and the cost of the alternative schemes were 18.18%, 36.36%, and 63.64% lower than the current scheme for alternative scheme 1, alternative scheme 2, and alternative scheme 3, respectively. From the societal perspective, when compared with the current scheme, the budgetary impact of the three alternative schemes were +66 million Chinese Yuan (CNY) (4.81%), +103 million CNY (7.53%), and +305million CNY (22.35%), respectively. The CMA considered a broader perspective of social costs and indicated that the alternative schemes would result in an overall saving of parents' transportation and work loss costs to bring their children for vaccination, translating into a total cost saving of 18.18%, 36.36%, 63.64%, comparing to the current scheme. Thus, fully or partly using the DTaP-IPV-Hib combination vaccine is cost-saving in the context of China.
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Affiliation(s)
- Bei Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China.,Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P.R. China
| | - Chao Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China.,Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yudong Miao
- Department of Health Policy and Management, College of Public Health, Zhengzhou University, Zhengzhou, P.R. China
| | - Sihui Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Tianshuo Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China.,Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
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