1
|
Duran-Fernandez R, Bernal-Serrano D, Garcia-Huitron JA, Hutubessy R. Financing for pandemic preparedness and response measures: a systematic scoping review. Bull World Health Organ 2024; 102:314-322F. [PMID: 38680465 PMCID: PMC11046164 DOI: 10.2471/blt.23.290207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. Methods We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals. Findings Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Conclusion Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.
Collapse
Affiliation(s)
- Roberto Duran-Fernandez
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | - Daniel Bernal-Serrano
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | | | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Hutubessy R, Agarwal R, Aryaputri ES. A finance and health collaboration to counter pandemic threats. Bull World Health Organ 2024; 102:366-367. [PMID: 38680471 PMCID: PMC11046144 DOI: 10.2471/blt.23.291014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, Avenue Appia 20, 1211Geneva 27, Switzerland
| | - Ruchir Agarwal
- Mossavar-Rahmani Center for Business & Government, Harvard Kennedy School, Cambridge, United States of America
| | | |
Collapse
|
3
|
White RG, Menzies NA, Portnoy A, Clark RA, Toscano CM, Weller C, Tufet Bayona M, Silal SP, Karron RA, Lee JS, Excler JL, Lauer JA, Giersing B, Lambach P, Hutubessy R, Jit M. The Full Value of Vaccine Assessments Concept-Current Opportunities and Recommendations. Vaccines (Basel) 2024; 12:435. [PMID: 38675817 PMCID: PMC11053419 DOI: 10.3390/vaccines12040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
For vaccine development and adoption decisions, the 'Full Value of Vaccine Assessment' (FVVA) framework has been proposed by the WHO to expand the range of evidence available to support the prioritization of candidate vaccines for investment and eventual uptake by low- and middle-income countries. Recent applications of the FVVA framework have already shown benefits. Building on the success of these applications, we see important new opportunities to maximize the future utility of FVVAs to country and global stakeholders and provide a proof-of-concept for analyses in other areas of disease control and prevention. These opportunities include the following: (1) FVVA producers should aim to create evidence that explicitly meets the needs of multiple key FVVA consumers, (2) the WHO and other key stakeholders should develop standardized methodologies for FVVAs, as well as guidance for how different stakeholders can explicitly reflect their values within the FVVA framework, and (3) the WHO should convene experts to further develop and prioritize the research agenda for outcomes and benefits relevant to the FVVA and elucidate methodological approaches and opportunities for standardization not only for less well-established benefits, but also for any relevant research gaps. We encourage FVVA stakeholders to engage with these opportunities.
Collapse
Affiliation(s)
- Richard G. White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.A.C.); (M.J.)
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Rebecca A. Clark
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.A.C.); (M.J.)
| | - Cristiana M. Toscano
- Department of Collective Health, Institute for Tropical Medicine and Public Health, Federal University of Goiás (UFG), Goiânia 74690-900, Brazil;
| | | | | | - Sheetal Prakash Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town 7701, South Africa;
- Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford OX3 7BN, UK
| | - Ruth A. Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Jung-Seok Lee
- Policy and Economic Research Department, International Vaccine Institute, Seoul 08826, Republic of Korea;
| | | | - Jeremy A. Lauer
- Department of Management Science, Strathclyde Business School, Strathclyde University, Glasgow G1 1XQ, UK;
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals Department, WHO, 1211 Geneva, Switzerland; (B.G.); (P.L.); (R.H.)
| | - Philipp Lambach
- Immunization, Vaccines and Biologicals Department, WHO, 1211 Geneva, Switzerland; (B.G.); (P.L.); (R.H.)
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, WHO, 1211 Geneva, Switzerland; (B.G.); (P.L.); (R.H.)
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.A.C.); (M.J.)
| |
Collapse
|
4
|
Jansen M, Spasenoska D, Nadjib M, Ararso D, Hutubessy R, Kahn AL, Lambach P. National Immunization Program Decision Making Using the CAPACITI Decision-Support Tool: User Feedback from Indonesia and Ethiopia. Vaccines (Basel) 2024; 12:337. [PMID: 38543971 PMCID: PMC10974132 DOI: 10.3390/vaccines12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/21/2024] Open
Abstract
To ensure that limited domestic resources are invested in the most effective interventions, immunization programs in low- and middle-income countries (LMICs) must prioritize a growing number of new vaccines while considering opportunities to optimize the vaccine portfolio, as well as other components of the health system. There is a strong impetus for immunization decision-making to engage and coordinate various stakeholders across the health system in prioritization. To address this, national immunization program decision-makers in LMICs collaborated with WHO to structure deliberation among stakeholders and document an evidence-based, context-specific, and transparent process for prioritization or selection among multiple vaccination products, services, or strategies. The output of this effort is the Country-led Assessment for Prioritization on Immunization (CAPACITI) decision-support tool, which supports using multiple criteria and stakeholder perspectives to evaluate trade-offs affecting health interventions, taking into account variable data quality. Here, we describe the user feedback from Indonesia and Ethiopia, two initial countries that piloted the CAPACITI decision-support tool, highlighting enabling and constraining factors. Potential immunization program benefits and lessons learned are also summarized for consideration in other settings.
Collapse
Affiliation(s)
- Maarten Jansen
- Immunization, Vaccines and Biologicals Department, World Health Organization, 1202 Geneva, Switzerland; (R.H.); (A.-L.K.); (P.L.)
| | - Dijana Spasenoska
- Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
| | - Mardiati Nadjib
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia;
| | - Desalegn Ararso
- Ethiopian Public Health Institute, Addis Ababa 1242, Ethiopia;
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, 1202 Geneva, Switzerland; (R.H.); (A.-L.K.); (P.L.)
| | - Anna-Lea Kahn
- Immunization, Vaccines and Biologicals Department, World Health Organization, 1202 Geneva, Switzerland; (R.H.); (A.-L.K.); (P.L.)
| | - Philipp Lambach
- Immunization, Vaccines and Biologicals Department, World Health Organization, 1202 Geneva, Switzerland; (R.H.); (A.-L.K.); (P.L.)
| |
Collapse
|
5
|
Levin A, Yeung KHT, Hutubessy R. Systematic review of cost projections of new vaccine introduction. Vaccine 2024; 42:1042-1050. [PMID: 38278630 PMCID: PMC10911080 DOI: 10.1016/j.vaccine.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/23/2023] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND A recent review of guidance documents on vaccine delivery costing revealed current guidance on cost projections for new vaccine introduction has gaps on methods of sampling, data collection and analysis. In preparation for updating the respective guidance, this systematic review was undertaken to qualitatively assess methodologies used in new vaccine cost projection studies. This will inform researchers and stakeholders about the methods of new vaccine introduction cost projections for strategic directions in countries where cost data are not available. METHODS We systematically searched four search engines (PubMed, Cochrane Open Access, Mendeley and Google Scholar) for articles on cost projections for new vaccines published between 1999 and 15 June 2022. We developed inclusion and exclusion criteria for the selection of articles and analyzed the results using a PRISMA 2020 flow diagram. RESULTS Out of 1,108 articles identified, 171 met the criteria for inclusion in the study. Half of the articles were from high-income countries (50%), and most cost projections were part of cost-effectiveness analysis (84%). The most common source of cost data was secondary national information (43%), followed by author's assumptions (17%), secondary international information (14%), and primary data collection (7%). 19% of studies didn't include costs to deliver vaccines in their cost estimation. Among studies that included secondary vaccine delivery costs, approximately half only calculated vaccine administration costs (50%), while 35% included incremental system costs and 15% utilized ingredients data. Two thirds of the studies were conducted to inform policymakers of the cost-effectiveness or cost-benefit of introducing the vaccine. CONCLUSIONS Half of the economic evaluations on new vaccine introductions only included partial vaccine delivery costs. Thus, total costs of vaccine introduction were often being underestimated in economic evaluations. This suggests that guidelines on economic evaluations and journals should recommend that authors include more extensive vaccine delivery costs in their studies.
Collapse
Affiliation(s)
- Ann Levin
- Levin & Morgan LLC, Bethesda, Maryland, United States
| | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland.
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland
| |
Collapse
|
6
|
Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
Collapse
Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| |
Collapse
|
7
|
Flandes X, Hansen CA, Palani S, Abbas K, Bennett C, Caro WP, Hutubessy R, Khazhidinov K, Lambach P, Maure C, Marshall C, Rojas DP, Rosewell A, Sahastrabuddhe S, Tufet M, Wilder-Smith A, Beasley DWC, Bourne N, Barrett ADT. Vaccine value profile for Chikungunya. Vaccine 2023:S0264-410X(23)00915-5. [PMID: 38407992 DOI: 10.1016/j.vaccine.2023.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 02/28/2024]
Abstract
Chikungunya virus (CHIKV) a mosquito-borne alphavirus is the causative agent of Chikungunya (CHIK), a disease with low mortality but high acute and chronic morbidity resulting in a high overall burden of disease. After the acute disease phase, chronic disease including persistent arthralgia is very common, and can cause fatigue and pain that is severe enough to limit normal activities. On average, around 40% of people infected with CHIKV will develop chronic arthritis, which may last for months or years. Recommendations for protection from CHIKV focus on infection control through preventing mosquito proliferation. There is currently no licensed antiviral drug or vaccine against CHIKV. Therefore, one of the most important public health impacts of vaccination would be to decrease burden of disease and economic losses in areas impacted by the virus, and prevent or reduce chronic morbidity associated with CHIK. This benefit would particularly be seen in Low and Middle Income Countries (LMIC) and socio-economically deprived areas, as they are more likely to have more infections and more severe outcomes. This 'Vaccine Value Profile' (VVP) for CHIK is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of vaccines in the development pipeline and vaccine-like products.This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations. All contributors have extensive expertise on various elements of the CHIK VVP and collectively aimed to identify current research and knowledge gaps.The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- Ximena Flandes
- Department of Preventative Medicine and Population Health and University of Texas Medical Branch, Galveston, TX, United States
| | - Clairissa A Hansen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Sunil Palani
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Kaja Abbas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | | | | | | | - Clara Maure
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Marta Tufet
- Gavi the Vaccine Alliance, Geneva, Switzerland
| | | | - David W C Beasley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States; Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, United States.
| | - Nigel Bourne
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, United States; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States.
| | - Alan D T Barrett
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States.
| |
Collapse
|
8
|
Veettil SK, Schwerer L, Kategeaw W, Toth D, Samore MH, Hutubessy R, Chaiyakunapruk N. Scoping review of modelling studies assessing the impact of disruptions to essential health services during COVID-19. BMJ Open 2023; 13:e071799. [PMID: 37751952 PMCID: PMC10533712 DOI: 10.1136/bmjopen-2023-071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies assessing the indirect impact of COVID-19 using mathematical models have increased in recent years. This scoping review aims to identify modelling studies assessing the potential impact of disruptions to essential health services caused by COVID-19 and to summarise the characteristics of disruption and the models used to assess the disruptions. METHODS Eligible studies were included if they used any models to assess the impact of COVID-19 disruptions on any health services. Articles published from January 2020 to December 2022 were identified from PubMed, Embase and CINAHL, using detailed searches with key concepts including COVID-19, modelling and healthcare disruptions. Two reviewers independently extracted the data in four domains. A descriptive analysis of the included studies was performed under the format of a narrative report. RESULTS This scoping review has identified a total of 52 modelling studies that employed several models (n=116) to assess the potential impact of disruptions to essential health services. The majority of the models were simulation models (n=86; 74.1%). Studies covered a wide range of health conditions from infectious diseases to non-communicable diseases. COVID-19 has been reported to disrupt supply of health services, demand for health services and social change affecting factors that influence health. The most common outcomes reported in the studies were clinical outcomes such as mortality and morbidity. Twenty-five studies modelled various mitigation strategies; maintaining critical services by ensuring resources and access to services are found to be a priority for reducing the overall impact. CONCLUSION A number of models were used to assess the potential impact of disruptions to essential health services on various outcomes. There is a need for collaboration among stakeholders to enhance the usefulness of any modelling. Future studies should consider disparity issues for more comprehensive findings that could ultimately facilitate policy decision-making to maximise benefits to all.
Collapse
Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Luke Schwerer
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Damon Toth
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| |
Collapse
|
9
|
Carter A, Msemburi W, Sim SY, Gaythorpe KAM, Lambach P, Lindstrand A, Hutubessy R. Modeling the impact of vaccination for the immunization Agenda 2030: Deaths averted due to vaccination against 14 pathogens in 194 countries from 2021 to 2030. Vaccine 2023:S0264-410X(23)00854-X. [PMID: 37537094 DOI: 10.1016/j.vaccine.2023.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The Immunization Agenda 2030 (IA2030) Impact Goal 1.1. aims to reduce the number of future deaths averted through immunization in the next decade. To estimate the potential impact of the aspirational coverage targets for IA2030, we developed an analytical framework and estimated the number of deaths averted due to an ambitious vaccination coverage scenario from 2021 to 2030 in 194 countries. METHOD A demographic model was used to determine annual age-specific mortality estimates associated with vaccine coverage rates. For ten pathogens (Hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, yellow fever), we derived single measures of country-, age-, and pathogen-specific relative risk of deaths conditional upon coverage rates, leveraging the data from 18 modeling groups as part of the Vaccine Impact Model Consortium (VIMC) for 110 countries. We used a logistic regression model to extrapolate the relative risk estimates to countries that were not modeled by VIMC. For four pathogens (diphtheria, tetanus, pertussis and tuberculosis), we used estimates from the Global Burden of Disease 2019 study and existing literature on vaccine efficacy. A future scenario defining years of vaccine introduction and scale-up needed to reach aspirational targets was developed as an input to estimate the long-term impact of vaccination taking place from 2021 to 2030. FINDINGS Overall, an estimated 51.5 million (95 % CI: 44.0-63.2) deaths are expected to be averted due to vaccinations administered between the years 2021 and 2030. With immunization coverage projected to increase over 2021-2030 an average of 5.2 million per year (4.4-6.3) deaths will be averted annually, with 4.4 million (3.9-5.1) deaths be averted for the year 2021, gradually rising to 5.8 million (4.9-7.5) deaths averted in 2030. The largest proportion of deaths is attributed to Measles and Hepatitis B accounting for 18.8 million (17.8-20.0) and 14.0 million (11.5-16.9) of total deaths averted respectively. INTERPRETATION The results from this global analysis demonstrate the substantial potential mortality reductions achievable if the IA2030 targets are met by 2030. Deaths caused by vaccine preventable diseases disproportionately affect LMICs in the African region.
Collapse
Affiliation(s)
- Austin Carter
- University of Washington, Seattle, WA, USA; World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - William Msemburi
- World Health Organization, Division of Data, Analytics and Delivery for Impact (DDI), Geneva, Switzerland.
| | - So Yoon Sim
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | | | - Philipp Lambach
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Ann Lindstrand
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Raymond Hutubessy
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| |
Collapse
|
10
|
Hutubessy R, Lauer JA, Giersing B, Sim SY, Jit M, Kaslow D, Botwright S. The Full Value of Vaccine Assessments (FVVA): a framework for assessing and communicating the value of vaccines for investment and introduction decision-making. BMC Med 2023; 21:229. [PMID: 37400797 PMCID: PMC10318807 DOI: 10.1186/s12916-023-02929-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/08/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Several economic obstacles can deter the development and use of vaccines. This can lead to limited product options for some diseases, delays in new product development, and inequitable access to vaccines. Although seemingly distinct, these obstacles are actually interrelated and therefore need to be addressed through a single over-arching strategy encompassing all stakeholders. METHODS To help overcome these obstacles, we propose a new approach, the Full Value of Vaccines Assessments (FVVA) framework, to guide the assessment and communication of the value of a vaccine. The FVVA framework is designed to facilitate alignment across key stakeholders and to enhance decision-making around investment in vaccine development, policy-making, procurement, and introduction, particularly for vaccines intended for use in low- and middle-income countries. RESULTS The FVVA framework has three key elements. First, to enhance assessment, existing value-assessment methods and tools are adapted to include broader benefits of vaccines as well as opportunity costs borne by stakeholders. Second, to improve decision-making, a deliberative process is required to recognize the agency of stakeholders and to ensure country ownership of decision-making and priority setting. Third, the FVVA framework provides a consistent and evidence-based approach that facilitates communication about the full value of vaccines, helping to enhance alignment and coordination across diverse stakeholders. CONCLUSIONS The FVVA framework provides guidance for stakeholders organizing global-level efforts to promote investment in vaccines that are priorities for LMICs. By providing a more holistic view of the benefits of vaccines, its application also has the potential to encourage greater take-up by countries, thereby leading to more sustainable and equitable impacts of vaccines and immunization programmes.
Collapse
Affiliation(s)
- Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Jeremy A. Lauer
- Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - So Yoon Sim
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Kaslow
- PATH Center for Vaccine Innovation and Access, Seattle, USA
| | - Siobhan Botwright
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| |
Collapse
|
11
|
Patikorn C, Cho JY, Lambach P, Hutubessy R, Chaiyakunapruk N. Equity-Informative Economic Evaluations of Vaccines: A Systematic Literature Review. Vaccines (Basel) 2023; 11:622. [PMID: 36992206 PMCID: PMC10057152 DOI: 10.3390/vaccines11030622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
The Immunization Agenda 2030 prioritizes the populations without access to vaccines. Health equity has been increasingly incorporated into economic evaluations of vaccines to foster equitable access. Robust and standardized methods are needed to evaluate the health equity impact of vaccination programs to ensure monitoring and effective addressing of inequities. However, methods currently in place vary and potentially affect the application of findings to inform policy decision-making. We performed a systematic review by searching PubMed, Embase, Econlit, and the CEA Registry up to 15 December 2022 to identify equity-informative economic evaluations of vaccines. Twenty-one studies were included that performed health equity impact analysis to estimate the distributional impact of vaccines, such as deaths averted and financial risk protection, across equity-relevant subgroups. These studies showed that the introduction of vaccines or improved vaccination coverage resulted in fewer deaths and higher financial risk benefits in subpopulations with higher disease burdens and lower vaccination coverage-particularly poorer income groups and those living in rural areas. In conclusion, methods to incorporate equity have been evolving progressively. Vaccination programs can enhance equity if their design and implementation address existing inequities in order to provide equitable vaccination coverage and achieve health equity.
Collapse
Affiliation(s)
- Chanthawat Patikorn
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10540, Thailand
| | - Jeong-Yeon Cho
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84112, USA
| |
Collapse
|
12
|
Procter SR, Gonçalves BP, Paul P, Chandna J, Seedat F, Koukounari A, Hutubessy R, Trotter C, Lawn JE, Jit M. Maternal immunisation against Group B Streptococcus: A global analysis of health impact and cost-effectiveness. PLoS Med 2023; 20:e1004068. [PMID: 36917564 PMCID: PMC10013922 DOI: 10.1371/journal.pmed.1004068] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) can cause invasive disease (iGBS) in young infants, typically presenting as sepsis or meningitis, and is also associated with stillbirth and preterm birth. GBS vaccines are under development, but their potential health impact and cost-effectiveness have not been assessed globally. METHODS AND FINDINGS We assessed the health impact and value (using net monetary benefit (NMB), which measures both health and economic effects of vaccination into monetary units) of GBS maternal vaccination in an annual cohort of 140 million pregnant women across 183 countries in 2020. Our analysis uses a decision tree model, incorporating risks of GBS-related health outcomes from an existing Bayesian disease burden model. We extrapolated country-specific GBS-related healthcare costs using data from a previous systematic review and calculated quality-adjusted life years (QALYs) lost due to infant mortality and long-term disability. We assumed 80% vaccine efficacy against iGBS and stillbirth, following the WHO Preferred Product Characteristics, and coverage based on the proportion of pregnant women receiving at least 4 antenatal visits. One dose was assumed to cost $50 in high-income countries, $15 in upper-middle income countries, and $3.50 in low-/lower-middle-income countries. We estimated NMB using alternative normative assumptions that may be adopted by policymakers. Vaccinating pregnant women could avert 127,000 (95% uncertainty range 63,300 to 248,000) early-onset and 87,300 (38,100 to 209,000) late-onset infant iGBS cases, 31,100 deaths (14,400 to 66,400), 17,900 (6,380 to 49,900) cases of moderate and severe neurodevelopmental impairment, and 23,000 (10,000 to 56,400) stillbirths. A vaccine effective against GBS-associated prematurity might also avert 185,000 (13,500 to 407,000) preterm births. Globally, a 1-dose vaccine programme could cost $1.7 billion but save $385 million in healthcare costs. Estimated global NMB ranged from $1.1 billion ($-0.2 to 3.8 billion) under the least favourable normative assumptions to $17 billion ($9.1 to 31 billion) under the most favourable normative assumptions. The main limitation of our analysis was the scarcity of data to inform some of the model parameters such as those governing health-related quality of life and long-term costs from disability, and how these parameters may vary across country contexts. CONCLUSIONS In this study, we found that maternal GBS vaccination could have a large impact on infant morbidity and mortality. Globally, a GBS maternal vaccine at reasonable prices is likely to be a cost-effective intervention.
Collapse
Affiliation(s)
- Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
13
|
Hsiao A, Struckmann V, Stephani V, Mmbando D, Changalucha J, Baisley K, Levin A, Morgan W, Hutubessy R, Watson-Jones D, Whitworth H, Quentin W. Costs of delivering human papillomavirus vaccination using a one- or two-dose strategy in Tanzania. Vaccine 2023; 41:372-379. [PMID: 36460537 PMCID: PMC9831118 DOI: 10.1016/j.vaccine.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As part of the Dose Reduction Immunobridging and Safety Study of Two HPV Vaccines in Tanzanian Girls (DoRIS; NCT02834637), the current study is one of the first to evaluate the financial and economic costs of the national rollout of an HPV vaccination program in school-aged girls in sub-Saharan Africa and the potential costs associated with a single dose HPV vaccine program, given recent evidence suggesting that a single dose may be as efficacious as a two-dose regimen. METHODS The World Health Organization's (WHO) Cervical Cancer Prevention and Control Costing (C4P) micro-costing tool was used to estimate the total financial and economic costs of the national vaccination program from the perspective of the Tanzanian government. Cost data were collected in 2019 via surveys, workshops, and interviews with local stakeholders for vaccines and injection supplies, microplanning, training, sensitization, service delivery, supervision, and cold chain. The cost per two-dose and one-dose fully immunized girl (FIG) was calculated. RESULTS The total financial and economic costs were US$10,117,455 and US$45,683,204, respectively, at a financial cost of $5.17 per two-dose FIG, and an economic cost of $23.34 per FIG. Vaccine and vaccine-related costs comprised the largest proportion of costs, followed by service delivery. In a one-dose scenario, the cost per FIG reduced to $2.51 (financial) and $12.18 (economic), with the largest reductions in vaccine and injection supply costs, and service delivery. CONCLUSIONS The overall cost of Tanzania's HPV vaccination program was lower per vaccinee than costs estimated from previous demonstration projects in the region, especially in a single-dose scenario. Given the WHO Strategic Advisory Group of Experts on Immunization's recent recommendation to update dosing schedules to either one or two doses of the HPV vaccine, these data provide important baseline data for Tanzania and may serve as a guide for improving coverage going forward. The findings may also aid in the prioritization of funding for countries that have not yet added HPV vaccines to their routine immunizations.
Collapse
Affiliation(s)
- Amber Hsiao
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany.
| | - Verena Struckmann
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Victor Stephani
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany; HelloBetter, Oranienburger Str. 86A, 10178 Berlin, Germany
| | - Devis Mmbando
- Mwanza Intervention Trials Unit (MITU), Isamilo Street, P.O. Box 11936, Mwanza, Tanzania
| | - John Changalucha
- Mwanza Intervention Trials Unit (MITU), Isamilo Street, P.O. Box 11936, Mwanza, Tanzania
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, London, United Kingdom
| | - Ann Levin
- Levin & Morgan, LLC, Bethesda, MD, USA
| | | | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization (WHO), CH-1211 Geneva 27, Geneva, Switzerland
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit (MITU), Isamilo Street, P.O. Box 11936, Mwanza, Tanzania; London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, London, United Kingdom
| | - Hilary Whitworth
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, London, United Kingdom
| | - Wilm Quentin
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| |
Collapse
|
14
|
Song D, Pallas SW, Shimpi R, Ramaswamy N, Haldar P, Harvey P, Bhatnagar P, Katkar A, Jayaprasad N, Kunwar A, Bahl S, Morgan W, Hutubessy R, Date K, Mogasale V. Delivery cost of the first public sector introduction of typhoid conjugate vaccine in Navi Mumbai, India. PLOS Glob Public Health 2023; 3:e0001396. [PMID: 36962873 PMCID: PMC10022355 DOI: 10.1371/journal.pgph.0001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023]
Abstract
Navi Mumbai Municipal Corporation (NMMC), a local government in Mumbai, India, implemented the first public sector TCV campaign in 2018. This study estimated the delivery costs of this TCV campaign using a Microsoft Excel-based tool based on a micro-costing approach from the government (NMMC) perspective. The campaign's financial (direct expenditures) and economic costs (financial costs plus the monetized value of additional donated or existing items) incremental to the existing immunization program were collected. The data collection methods involved consultations with NMMC staff, reviews of financial and programmatic records of NMMC and the World Health Organization (WHO), and interviews with the health staff of sampled urban health posts (UHPs). Three UHPs were purposively sampled, representing the three dominant residence types in the catchment area: high-rise, slum, and mixed (high-rise and slum) areas. The high-rise area UHP had lower vaccination coverage (47%) compared with the mixed area (71%) and slum area UHPs (76%). The financial cost of vaccine and vaccination supplies (syringes, safety boxes) was $1.87 per dose, and the economic cost was $2.96 per dose in 2018 US dollars. Excluding the vaccine and vaccination supplies cost, the financial delivery cost across the 3 UHPs ranged from $0.37 to $0.53 per dose, and the economic delivery cost ranged from $1.37 to $3.98 per dose, with the highest delivery costs per dose in the high-rise areas. Across all 11 UHPs included in the campaign, the weighted average financial delivery cost was $0.38 per dose, and the economic delivery cost was $1.49 per dose. WHO has recommended the programmatic use of TCV in typhoid-endemic countries, and Gavi has included TCV in its vaccine portfolio. This first costing study of large-scale TCV introduction within a public sector immunization program provides empirical evidence for policymakers, stakeholders, and future vaccine campaign planning.
Collapse
Affiliation(s)
- Dayoung Song
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Sarah W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rahul Shimpi
- World Health Organization, India Country Office, New Delhi, India
| | - N Ramaswamy
- Navi Mumbai Municipal Corporation, Navi Mumbai, India
| | - Pradeep Haldar
- Ministry of Family Health and Welfare, Government of India, New Delhi, India
| | - Pauline Harvey
- World Health Organization, India Country Office, New Delhi, India
| | - Pankaj Bhatnagar
- World Health Organization, India Country Office, New Delhi, India
| | - Arun Katkar
- World Health Organization, India Country Office, New Delhi, India
| | | | - Abhishek Kunwar
- World Health Organization, India Country Office, New Delhi, India
| | - Sunil Bahl
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Win Morgan
- Levin and Morgan LLC, Bethesda, MD, United States of America
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vittal Mogasale
- Policy and Economic Research Department, International Vaccine Institute, Republic of Korea
| |
Collapse
|
15
|
Sriudomporn S, Watts E, Yoon Sim S, Hutubessy R, Patenaude B. Achieving immunization agenda 2030 coverage targets for 14 pathogens: Projected product and immunization delivery costs for 194 Countries, 2021-2030. Vaccine X 2022; 13:100256. [PMID: 36686400 PMCID: PMC9850055 DOI: 10.1016/j.jvacx.2022.100256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Understanding the level of investment needed for the next decade is vital to achieve the goal of Immunization Agenda 2030 (IA2030). Through the immunization funder perspective, this study estimates both global and regional economic resources required to achieve IA2030 coverage among 194 WHO member countries from 2021 to 2030, against 14 pathogens: Hepatitis B (Hep B), Haemophilus influenzae type b (Hib), Human papillomavirus (HPV), Japanese encephalitis (JE), Measles, Meningitis A (Men A), Streptococcus pneumoniae, Rotavirus, Rubella, Yellow Fever (YF), Diphtheria, Tetanus, Pertussis, and Tuberculosis. The total cost of immunization program, routine vaccine, routine delivery, and non-routine costs (SIA and stockpile) were estimated using WHO coverage forecast for IA2030. Incremental costs of achieving IA2030 for all vaccines and cost per immunized child were also assessed. All costs were calculated for each income and regional level, as well as global level. Scenario analysis and sensitivity analysis were conducted to account for uncertainty in future vaccine pricing and delivery costs. The total cost of immunization programs is $269.8 billion (95% confidence interval: $247.1 - $311.8), of which $152.8 billion is considered as routine vaccine cost, $114.9 billion is routine delivery cost. Non- routine cost for LICs and LMICs totaled $2.1 billion. The incremental cost of achieving coverage goals after 2020 is $89.9 billion ($27.7-$110.1), with upper-middle income countries requiring the largest increase in investment (56.2% of incremental costs). The average immunization cost per child across all countries is $192.6. Scenario analysis using the minimum and maximum vaccines price for fully self-financing countries resulted in total costs ranging from $193.6 and $552.2 billion. The immunization program cost among 194 WHO member countries is expected to increase during this decade. The strategy for resource mobilization and increasing investment from country governments and donors are essential to achieving IA2030 coverage and ensuring sustainable immunization programs.
Collapse
Affiliation(s)
- Salin Sriudomporn
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: 415 N Washington St., Baltimore, MD 20231, USA.
| | - Elizabeth Watts
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - So Yoon Sim
- Immunization Analysis & Insights (IAI) unit, Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Immunization Analysis & Insights (IAI) unit, Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
16
|
Levin A, Yuma S, Swai E, Morgan W, Gauvreau CL, Broutet N, Yeung KHT, Hutubessy R. Comprehensive approach to costing cervical cancer prevention and control: a case study in the United Republic of Tanzania using the Cervical Cancer Prevention and Control Costing (C4P) tool. BMC Med 2022; 20:384. [PMID: 36316680 PMCID: PMC9623962 DOI: 10.1186/s12916-022-02576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/22/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has developed a costing tool, the Cervical Cancer Prevention and Control Costing (C4P) tool, to estimate the comprehensive cost of cervical cancer primary, secondary and tertiary prevention in low- and middle-income countries. The tool was piloted in the United Republic of Tanzania, a country with a high incidence of cervical cancer with 62.5 cases per 100,000 women in 2020. This paper presents the costing tool methods as well as the results from the pilot in Tanzania. METHODS The C4P tool estimates the incremental costs of cervical cancer prevention and control programmes. It estimates the financial (monetary costs to the government) and economic costs (opportunity costs). For the pilot, the study team collected data on costs and programme assumptions for human papillomavirus (HPV) vaccination of 14-year-old girls and scaling up of cervical cancer screening (visual inspection with acetic acid and HPV-DNA testing) and treatment for women for 2020-2024. Assumptions were made on how vaccination coverage would increase over the 5 years as well as developing additional screening and treatment capacity through health personnel training and infrastructure strengthening. RESULTS The total financial and economic costs of the comprehensive programme during 2020-2024 are projected to be US$68 million and US$124 million, respectively. The financial and economic costs of a fully immunized girl with HPV vaccine are estimated to be US$6.68 and US$17.31, respectively, while the costs per woman screened for cervical cancer are, on average, US$4.02 and US$5.83, respectively; US$6.44 and US$9.37 for pre-cancer treatment, respectively; and US$101 and US$107 for diagnosis of invasive cancer, respectively. The cost of treating and managing invasive cancer range from US$7.05 and US$7.83 for outpatient palliative care to US$800.21 and US$893.80 for radiotherapy, respectively. CONCLUSIONS The C4P costing tool can assist national cervical cancer programmes to estimate monetary resources needed as well as opportunity costs of reducing national cervical cancer incidence through primary, secondary and tertiary prevention.
Collapse
Affiliation(s)
| | - Safina Yuma
- Ministry of Health, Dodoma, United Republic of Tanzania
| | - Edwin Swai
- World Health Organization, Dar es Salaam, United Republic of Tanzania
| | | | - Cindy L Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| |
Collapse
|
17
|
Struckmann V, Stephani V, Hsiao A, Mbbando D, Changalucha J, Baisley K, Levin A, Hutubessy R, Watson-Jones D, Quentin W. Costs of delivering human papillomavirus vaccination in Tanzania. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cervical cancer caused by human papillomavirus (HPV) is the most frequent cancer in women in many low-income countries.Tanzania implemented a national HPV vaccination program in 2018 using a two-dose quadrivalent HPV vaccine. This study aimed to (1) estimate financial and economic costs of a two-dose vaccination program based on experiences with the national vaccination program, (2) estimate costs of a one-dose vaccination schedule to enable future cost-effectiveness analyses, and (3) assess the effect of alternative assumptions for future vaccination coverage rates on estimated costs of vaccination.
Methods
The WHO Cervical Cancer Prevention and Control Costing (C4P) tool was used to estimate the incremental costs of the national vaccination programme from the perspective of the Tanzanian government using data collected via surveys, workshops, and interviews with local stakeholders. Deterministic sensitivity analyses were performed to estimate the effect of alternative assumptions for coverage rates and delivery strategies and to assess the impact of a potential one-dose vaccination schedule.
Results
The total financial and economic costs were US$10,117,455 and US$45,683,204, respectively, at a financial cost of $5.17 per two-dose fully immunized girl (FIG), and an economic cost of $23.34 per FIG. Under the assumption of a one-dose vaccination schedule, costs per FIG would reduce to financial costs of $2.51 and economic costs of $12.18.
Conclusions
The overall cost of Tanzania’s HPV vaccination program was lower per vaccinee than previous demonstration projects in the region suggest. These data provide important baseline data for Tanzania’s HPV vaccination program to date and may serve as a guide for improving coverage going forward. The findings may also aid in the prioritization of funding for countries that have not yet added HPV vaccines to their routine immunizations.
Key messages
• If a single dose regimen were found to be as effective as a two-dose series, it would result in significant cost savings as well as an increase in the number of girls that could be reached.
• School-based vaccinations resulted in the lowest price per fully immunized girl, but other settings are needed to achieve equitable high coverage of HPV vaccination in Tanzania.
Collapse
Affiliation(s)
| | - V Stephani
- HelloBetter , Berlin, Germany
- TU Berlin, Berlin, Germany
| | | | - D Mbbando
- Mwanza Intervention Trials Unit , Mwanza, Tanzania
| | | | | | - A Levin
- Levin & Morgan, Bethesda, USA
| | - R Hutubessy
- Immunization, Vaccines and Biologicals Department, WHO , Geneva, Switzerland
| | - D Watson-Jones
- Mwanza Intervention Trials Unit , Mwanza, Tanzania
- LSHTM, London, UK
| | | |
Collapse
|
18
|
Frey K, Hagedorn B, McCarthy KA, Hutubessy R, Wang SA. Modeling anticipated changes in numbers of SARS-CoV-2 infections within communities due to immunization campaigns. Gates Open Res 2022; 6:7. [PMID: 36299735 PMCID: PMC9576906 DOI: 10.12688/gatesopenres.13448.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background: As SARS-CoV-2 spread in early 2020, uncertainty about the scope, duration, and impact of the unfolding outbreaks caused numerous countries to interrupt many routine activities, including health services. Because immunization is an essential health service, modeling changes in SARS-CoV-2 infections among communities and health workers due to different vaccination activities was undertaken to understand the risks and to inform approaches to resume services. Methods: Agent-based modeling examined the impact of Supplemental Immunization Activities (SIAs) delivery strategies on SARS-CoV-2 transmission in communities and health workers for six countries capturing various demographic profiles and health system performance: Angola, Ecuador, Lao PDR, Nepal, Pakistan, and Ukraine. Results: Urban, fixed-post SIAs during periods of high SARS-CoV-2 prevalence increased infections within the community by around 28 [range:0-79] per 1000 vaccinations. House-to-house SIAs in mixed urban and rural contexts may import infections into previously naïve communities. Infections are elevated by around 60 [range:0-230] per 1000 vaccinations, but outcomes are sensitive to prevalence in health workers and SIA timing relative to peak. Conclusions: Incremental increases in SARS-CoV-2 infection due to SIAs was small and in proportion to overall prevalence. Younger populations experience lower transmission intensity and fewer excess infections per childhood vaccine delivered. Large rural populations have lower transmission intensity but face a greater risk of introduction of SARS-CoV-2 during an SIA.
Collapse
Affiliation(s)
- Kurt Frey
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Brittany Hagedorn
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | | | | |
Collapse
|
19
|
Dilokthornsakul P, Veettil SK, Lan LM, Thakkinstian A, Hutubessy R, Lambach P, Chaiyakunapruk N. Combining cost-effectiveness results into a single measurement: What is the value?: Authors response. EClinicalMedicine 2022; 51:101565. [PMID: 35865737 PMCID: PMC9294237 DOI: 10.1016/j.eclinm.2022.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Piyameth Dilokthornsakul
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai, Thailand
| | - Sajesh K Veettil
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Le My Lan
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| |
Collapse
|
20
|
Prudden HJ, Achilles SL, Schocken C, Broutet N, Canfell K, Akaba H, Basu P, Bhatla N, Chirenje ZM, Delany-Moretlwe S, Denny L, Gamage DG, Herrero R, Hutubessy R, Villa LL, Murillo R, Schiller JT, Stanley M, Temmerman M, Zhao F, Ogilvie G, Kaslow DC, Dull P, Gottlieb SL. Understanding the public health value and defining preferred product characteristics for therapeutic human papillomavirus (HPV) vaccines: World Health Organization consultations, October 2021-March 2022. Vaccine 2022; 40:5843-5855. [PMID: 36008233 DOI: 10.1016/j.vaccine.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) global strategy to eliminate cervical cancer (CxCa) could result in >62 million lives saved by 2120 if strategy targets are reached and maintained: 90% of adolescent girls receiving prophylactic human papillomavirus (HPV) vaccine, 70% of women receiving twice-lifetime cervical cancer screening, and 90% of cervical pre-cancer lesions and invasive CxCa treated. However, the cost and complexity of CxCa screening and treatment approaches has hampered scale-up, particularly in low- and middle-income countries (LMICs), and new approaches are needed. Therapeutic HPV vaccines (TxV), which could clear persistent high-risk HPV infection and/or cause regression of pre-cancerous lesions, are in early clinical development and might offer one such approach. During October 2021 to March 2022, WHO, in collaboration with the Bill and Melinda Gates Foundation, convened a series of global expert consultations to lay the groundwork for understanding the potential value of TxV in the context of current CxCa prevention efforts and for defining WHO preferred product characteristics (PPCs) for TxV. WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper reports on the main discussion points and findings from the expert consultations. Experts identified several ways in which TxV might address challenges in current CxCa prevention programmes, but emphasized that the potential value of TxV will depend on their degree of efficacy and how quickly they can be developed and implemented relative to ongoing scale-up of existing interventions. Consultation participants also discussed potential use-cases for TxV, important PPC considerations (e.g., vaccine indications, target populations, and delivery strategies), and critical modelling needs for predicting TxV impact and cost-effectiveness.
Collapse
Affiliation(s)
| | | | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Australia
| | | | - Partha Basu
- International Agency for Research on Cancer, France
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Lynette Denny
- University of Cape Town, SA MRC Gynaecology Cancer Research, South Africa
| | | | | | | | | | | | | | | | | | - Fanghui Zhao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Gina Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Canada
| | | | | | | | | |
Collapse
|
21
|
Le LM, Veettil SK, Donaldson D, Kategeaw W, Hutubessy R, Lambach P, Chaiyakunapruk N. The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis. J Am Pharm Assoc (2003) 2022; 62:1499-1513.e16. [PMID: 35961937 PMCID: PMC9448680 DOI: 10.1016/j.japh.2022.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Background The underutilization of immunization services remains a big public health concern. Pharmacists can address this concern by playing an active role in immunization administration. Objective We performed a systematic review and meta-analysis to assess the impact of pharmacist-involved interventions on immunization rates and other outcomes indirectly related to vaccine uptake. Methods A systematic literature search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception to February 2022 to identify randomized controlled trials (RCTs) and observational studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Meta-analyses were performed using a random-effects model. Results A total of 14 RCTs and 79 observational studies were included. Several types of immunizations were provided, including influenza, pneumococcal, herpes zoster, Tdap, and others in a variety of settings (community pharmacy, hospital, clinic, others). Pooled analyses from RCTs indicated that a pharmacist as immunizer (risk ratio 1.14 [95% CI 1.12–1.15]), advocator (1.31 [1.17–1.48]), or both (1.14 [1.12–1.15]) significantly increased immunization rates compared with usual care or non–pharmacist-involved interventions. The quality of evidence was assessed as moderate or low for those meta-analyses. Evidence from observational studies was consistent with the results found in the analysis of the RCTs. Conclusion Pharmacist involvement as immunizer, advocator, or both roles has favorable effects on immunization uptake, especially with influenza vaccines in the United States and some high-income countries. As the practice of pharmacists in immunization has been expanded globally, further research on investigating the impact of pharmacist involvement in immunization in other countries, especially developing ones, is warranted.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nathorn Chaiyakunapruk
- Correspondence: Nathorn Chaiyakunapruk, PharmD, PhD, Professor. Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 S 2000 E, Salt Lake City, UT 84112.
| |
Collapse
|
22
|
Dilokthornsakul P, Lan LM, Thakkinstian A, Hutubessy R, Lambach P, Chaiyakunapruk N. Economic evaluation of seasonal influenza vaccination in elderly and health workers: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101410. [PMID: 35497069 PMCID: PMC9046113 DOI: 10.1016/j.eclinm.2022.101410] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A number of cost-effectiveness analysis of influenza vaccination have been conducted to estimate value of influenza vaccines in elderly and health workers (HWs). This study aims to summarize cost-effectiveness evidence by pooling the incremental net monetary benefit (INMB) of influenza vaccination. METHODS A systematic review was performed in electronic databases from their inceptions to February 2022. Cost-effectiveness studies reporting quality-adjusted life year (QALY), or life year (LY) of influenza vaccination were included. Stratified meta-analyses by population, perspective, country income-level, and herd-effect were performed to pool INMB across studies. The protocol was registered at PROSPERO (CRD42021246746). FINDINGS A total of 21 studies were included. Eighteen studies were conducted in elderly, two studies were conducted in HWs, and one study was conducted in both elderly and HWs. According to pre-specified analyses, studies for elderly in high-income economies (countries) (HIEs) and upper-middle income economies (UMIEs) without herd effect could be pooled. For HIEs under a societal perspective, the perspective which identify all relevant costs occurred in the society including direct medical cost, direct non-medical cost and indirect cost, pooled INMB was $217·38 (206·23, 228·53, I2 =28.2%), while that for healthcare provider/payer perspective was $0·20 (-11,908·67, 11,909·07, I2 = 0.0%). For societal perspective in UMIEs, pooled INMB was $28·39 (-190·65, 133·87, I2 = 92.8%). The findings were robust across a series of sensitivity analyses for HIEs. Studies in HWs indicated that influenza vaccination was cost-effective compared to no vaccination or current practice. INTERPRETATION Influenza vaccination might be cost-effective for HWs and elderly in HIEs under a societal perspective with relatively small variations among included studies, while there remains limited evidence for healthcare provider/payer perspective or other level of incomes. Further evidence is warranted. FUNDING This study was funded by a grant of Immunization, Vaccine and Biologicals department of the World Health Organization. The authors would like to acknowledge the contributions of the US CDC which provided financial support to the development and publication of this report. Grant number US CDC, WHO IVR (U50CK000431).
Collapse
Affiliation(s)
- Piyameth Dilokthornsakul
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Le My Lan
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, United States
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
- Corresponding author: Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- Corresponding author: Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, United States.
| |
Collapse
|
23
|
Fraser H, Tombe-Mdewa W, Kohli-Lynch C, Hofman K, Tempia S, McMorrow M, Lambach P, Ramkrishna W, Cohen C, Hutubessy R, Edoka I. Costs of seasonal influenza vaccination in South Africa. Influenza Other Respir Viruses 2022; 16:873-880. [PMID: 35355414 PMCID: PMC9343325 DOI: 10.1111/irv.12987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza accounts for a substantial number of deaths and hospitalisations annually in South Africa. To address this disease burden, the South African National Department of Health introduced a trivalent inactivated influenza vaccination programme in 2010. Methods We adapted and populated the WHO Seasonal Influenza Immunization Costing Tool (WHO SIICT) with country‐specific data to estimate the cost of the influenza vaccination programme in South Africa. Data were obtained through key‐informant interviews at different levels of the health system and through a review of existing secondary data sources. Costs were estimated from a public provider perspective and expressed in 2018 prices. We conducted scenario analyses to assess the impact of different levels of programme expansion and the use of quadrivalent vaccines on total programme costs. Results Total financial and economic costs were estimated at approximately USD 2.93 million and USD 7.91 million, respectively, while financial and economic cost per person immunised was estimated at USD 3.29 and USD 8.88, respectively. Expanding the programme by 5% and 10% increased economic cost per person immunised to USD 9.36 and USD 9.52 in the two scenarios, respectively. Finally, replacing trivalent inactivated influenza vaccine (TIV) with quadrivalent vaccine increased financial and economic costs to USD 4.89 and USD 10.48 per person immunised, respectively. Conclusion We adapted the WHO SIICT and provide estimates of the total costs of the seasonal influenza vaccination programme in South Africa. These estimates provide a basis for planning future programme expansion and may serve as inputs for cost‐effectiveness analyses of seasonal influenza vaccination programmes.
Collapse
Affiliation(s)
- Heather Fraser
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Winfrida Tombe-Mdewa
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,MassGenics, Duluth, Georgia, USA.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,US Public Health Service, Rockville, Maryland, USA
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, Pretoria, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
24
|
Levin A, Boonstoppel L, Brenzel L, Griffiths U, Hutubessy R, Jit M, Mogasale V, Pallas S, Resch S, Suharlim C, Yeung KHT. WHO-led consensus statement on vaccine delivery costing: process, methods, and findings. BMC Med 2022; 20:88. [PMID: 35255920 PMCID: PMC8902809 DOI: 10.1186/s12916-022-02278-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Differences in definitions and methodological approaches have hindered comparison and synthesis of economic evaluation results across multiple health domains, including immunization. At the request of the World Health Organization's (WHO) Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC), WHO convened an ad hoc Vaccine Delivery Costing Working Group, comprising experts from eight organizations working in immunization costing, to address a lack of standardization and gaps in definitions and methodological guidance. The aim of the Working Group was to develop a consensus statement harmonizing terminology and principles and to formulate recommendations for vaccine delivery costing for decision making. This paper discusses the process, findings of the review, and recommendations in the Consensus Statement. METHODS The Working Group conducted several interviews, teleconferences, and one in-person meeting to identify groups working in vaccine delivery costing as well as existing guidance documents and costing tools, focusing on those for low- and middle-income country settings. They then reviewed the costing aims, perspectives, terms, methods, and principles in these documents. Consensus statement principles were drafted to align with the Global Health Cost Consortium costing guide as an agreed normative reference, and consensus definitions were drafted to reflect the predominant view across the documents reviewed. RESULTS The Working Group identified four major workstreams on vaccine delivery costing as well as nine guidance documents and eleven costing tools for immunization costing. They found that some terms and principles were commonly defined while others were specific to individual workstreams. Based on these findings and extensive consultation, recommendations to harmonize differences in terminology and principles were made. CONCLUSIONS Use of standardized principles and definitions outlined in the Consensus Statement within the immunization delivery costing community of practice can facilitate interpretation of economic evidence by global, regional, and national decision makers. Improving methodological alignment and clarity in program costing of health services such as immunization is important to support evidence-based policies and optimal resource allocation. On the other hand, this review and Consensus Statement development process revealed the limitations of our ability to harmonize given that study designs will vary depending upon the policy question that is being addressed and the country context.
Collapse
Affiliation(s)
| | | | | | | | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sarah Pallas
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephen Resch
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
25
|
Teerawattananon Y, Kc S, Chi YL, Dabak S, Kazibwe J, Clapham H, Lopez Hernandez C, Leung GM, Sharifi H, Habtemariam M, Blecher M, Nishtar S, Sarkar S, Wilson D, Chalkidou K, Gorgens M, Hutubessy R, Wibulpolprasert S. Recalibrating the notion of modelling for policymaking during pandemics. Epidemics 2022; 38:100552. [PMID: 35259693 PMCID: PMC8889889 DOI: 10.1016/j.epidem.2022.100552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 disease models have aided policymakers in low-and middle-income countries (LMICs) with many critical decisions. Many challenges remain surrounding their use, from inappropriate model selection and adoption, inadequate and untimely reporting of evidence, to the lack of iterative stakeholder engagement in policy formulation and deliberation. These issues can contribute to the misuse of models and hinder effective policy implementation. Without guidance on how to address such challenges, the true potential of such models may not be realised. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was formed to address this gap. CMCC is a global collaboration between decision-makers from LMICs, modellers and researchers, and development partners. To understand the limitations of existing COVID-19 disease models (primarily from high income countries) and how they could be adequately support decision-making in LMICs, a desk review of modelling experience during the COVID-19 and past disease outbreaks, two online surveys, and regular online consultations were held among the collaborators. Three key recommendations from CMCC include: A ‘fitness-for-purpose’ flowchart, a tool that concurrently walks policymakers (or their advisors) and modellers through a model selection and development process. The flowchart is organised around the following: policy aims, modelling feasibility, model implementation, model reporting commitment. Holmdahl and Buckee (2020) A ‘reporting standards trajectory’, which includes three gradually increasing standard of reports, ‘minimum’, ‘acceptable’, and ‘ideal’, and seeks collaboration from funders, modellers, and decision-makers to enhance the quality of reports over time and accountability of researchers. Malla et al. (2018) A framework for “collaborative modelling for effective policy implementation and evaluation” which extends the definition of stakeholders to funders, ground-level implementers, public, and other researchers, and outlines how each can contribute to modelling. We advocate for standardisation of modelling processes and adoption of country-owned model through iterative stakeholder participation and discuss how they can enhance trust, accountability, and public ownership to decisions. COVID-19 models need appropriate adaptation to reflect contextual differences across settings. Upholding scientific standards is equally important as providing evidence for policymaking during pandemics. Wider stakeholder engagement with an iterative process for re-evaluating decisions is required for effective policy implementation.
Collapse
Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | - Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand.
| | - Y-Ling Chi
- Centre for Global Development Europe, Great Peter House, Abbey Gardens, Great College St, Westminster, London SW1P 3SE, UK
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Hannah Clapham
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | | | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine (HKUMed), Hong Kong University, 21 Sassoon Rd, Pok Fu Lam, Hong Kong
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KMU), Kerman 7616911320, Iran
| | - Mahlet Habtemariam
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Streeet, Addis Ababa, Ethiopia
| | - Mark Blecher
- National Treasury, 120 Plein Street, Cape Town, Republic of South Africa
| | - Sania Nishtar
- Poverty Alleviation and Social Safety Division, Government of Pakistan, Cabinet Secretariat, 4th Floor, Evacuee Trust Complex, F-5/1, Islamabad, Pakistan
| | - Swarup Sarkar
- Indian Council for Medical Research (ICMR), Government of India, V. Ramalingaswami Bhawan, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India
| | - David Wilson
- Bill and Melinda Gates Foundation (BMGF), 500 5th Ave N, Seattle, WA 98109, USA
| | - Kalipso Chalkidou
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - Marelize Gorgens
- World Bank Group (WBG), 1818H Street, N.W., Washington, DC 20433, USA
| | - Raymond Hutubessy
- World Health Organisation (WHO), Avenue Appia 20, 1211 Geneva, Switzerland
| | - Suwit Wibulpolprasert
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Rd., Nonthaburi 11000, Thailand
| |
Collapse
|
26
|
Frey K, Hagedorn B, McCarthy KA, Hutubessy R, Wang SA. Modeling anticipated changes in numbers of SARS-CoV-2 infections within communities due to immunization campaigns. Gates Open Res 2022; 6:7. [DOI: 10.12688/gatesopenres.13448.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background: As SARS-CoV-2 spread in early 2020, uncertainty about the scope, duration, and impact of the unfolding outbreaks caused numerous countries to interrupt many routine activities, including health services. Because immunization is an essential health service, modeling changes in SARS-CoV-2 infections among communities and health workers due to different vaccination activities was undertaken to understand the risks and to inform approaches to resume services. Methods: Agent-based modeling examined the impact of Supplemental Immunization Activities (SIAs) delivery strategies on SARS-CoV-2 transmission in communities and health workers for six countries capturing various demographic profiles and health system performance: Angola, Ecuador, Lao PDR, Nepal, Pakistan, and Ukraine. Results: Urban, fixed-post SIAs during periods of high SARS-CoV-2 prevalence increased infections within the community by around 28 [range:0-79] per 1000 vaccinations. House-to-house SIAs in mixed urban and rural contexts may import infections into previously naïve communities. Infections are elevated by around 60 [range:0-230] per 1000 vaccinations, but outcomes are sensitive to prevalence in health workers and SIA timing relative to peak. Conclusions: Younger populations experience lower transmission intensity and fewer excess infections per childhood vaccine delivered. Large rural populations have lower transmission intensity but face a greater risk of introduction of SARS-CoV-2 during an SIA.
Collapse
|
27
|
Nonvignon J, Owusu R, Asare B, Adjagba A, Aund W, Karene Hoi Ting Y, Naa Korkoi Azeez J, Gyansa-Lutterodt M, Gulbi G, Amponsa-Achiano K, Dadzie F, Armah GE, Brenzel L, Hutubessy R, Resch SC. Estimating the cost of COVID-19 vaccine deployment and introduction in Ghana using the CVIC Tool. Vaccine 2022; 40:1879-1887. [PMID: 35190206 PMCID: PMC8813551 DOI: 10.1016/j.vaccine.2022.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/11/2022]
Abstract
Current COVID-19 vaccine supply market means LMICs will have to rely on a combination of different sources/types of vaccines to meet their demand. Deployment of COVID-19 vaccine plans in Ghana will cost $348.7–$436.1 million for coverage of 17.5 million of eligible Ghanaians. Vaccine cost constitute 78–83% of total cost whereas the total vaccination cost is 0.48–0.60% of the country’s 2020 GDP. The WHO-UNICEF CVIC tool is useful for comprehensive COVID-19 vaccine deployment costing and resource planning.
Background This study estimated cost of COVID-19 vaccine introduction and deployment in Ghana. Methods Using the WHO-UNICEF COVID-19 Vaccine Introduction and deployment Costing (CVIC) tool Ghana’s Ministry of Health Technical Working Group for Health Technology Assessment (TWG-HTA) in collaboration with School of Public Health, University of Ghana, organized an initial two-day workshop that brought together partners to deliberate and agree on input parameters to populate the CVIC tool. A further 2–3 days validation with the Expanded Program of Immunization (EPI) and other partners to finalize the analysis was done. Three scenarios, with different combinations of vaccine products and delivery modalities, as well as time period were analyzed. The scenarios included AstraZeneca (40%), Johnson & Johnson (J&J) (30%), Moderna, Pfizer, and Sputnik V at 10% each; with primary schedule completed by second half of 2021 (Scenario 1); AstraZeneca (30%), J&J (40%), Moderna, Pfizer, and Sputnik V at 10% each with primary schedule completed by first half of 2022 (Scenario 2); and equal distribution (20%) among AstraZeneca, J&J, Moderna, Pfizer, and Sputnik V with primary schedule completed by second half of 2022 (Scenario 3). Results The estimated total cost of COVID-19 vaccination ranges between $348.7 and $436.1 million for the target population of 17.5 million. These translate into per person completed primary schedule cost of $20.9–$26.2 and per dose (including vaccine cost) of $10.5–$13.1. Again, per person completed primary schedule excluding vaccine cost was $4.5 and $4.6, thus per dose excluding vaccine also ranged from $2.2 – $2.3. The main cost driver was vaccine doses, including shipping, which accounts for between 78% and 83% of total cost. Further, an estimated 8,437–10,247 vaccinators (non-FTEs) would be required during 2021–2022 to vaccinate using a mix of delivery strategies, accounting for 8–10% of total cost. Conclusion These findings provide the estimates to inform resource mobilization efforts by government and other partners.
Collapse
|
28
|
Drolet M, Laprise JF, Martin D, Jit M, Bénard É, Gingras G, Boily MC, Alary M, Baussano I, Hutubessy R, Brisson M. Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis. Lancet Infect Dis 2021; 21:1598-1610. [PMID: 34245682 PMCID: PMC8554391 DOI: 10.1016/s1473-3099(20)30860-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
Background Introduction of human papillomavirus (HPV) vaccination has been slow in low-income and middle-income countries (LMICs) because of resource constraints and worldwide shortage of vaccine supplies. To help inform WHO recommendations, we modelled various HPV vaccination strategies to examine the optimal use of limited vaccine supplies and best allocation of scarce resources in LMICs in the context of the WHO global call to eliminate cervical cancer as a public health problem. Methods In this mathematical modelling analysis, we developed HPV-ADVISE LMIC, a transmission-dynamic model of HPV infection and diseases calibrated to four LMICs: India, Vietnam, Uganda, and Nigeria. For different vaccination strategies that encompassed use of a nine-valent vaccine (or a two-valent or four-valent vaccine assuming high cross-protection), we estimated three outcomes: reduction in the age-standardised rate of cervical cancer, number of doses needed to prevent one case of cervical cancer (NNV; as a measure of efficiency), and the incremental cost-effectiveness ratio (ICER; in 2017 international $ per disability-adjusted life-year [DALY] averted). We examined different vaccination strategies by varying the ages of routine HPV vaccination and number of age cohorts vaccinated, the population targeted, and the number of doses used. In our base case, we assumed 100% lifetime protection against HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58; vaccination coverage of 80%; and a time horizon of 100 years. For the cost-effectiveness analysis, we used a 3% discount rate. Elimination of cervical cancer was defined as an age-standardised incidence of less than four cases per 100 000 woman-years. Findings We predicted that HPV vaccination could lead to cervical cancer elimination in Vietnam, India, and Nigeria, but not in Uganda. Compared with no vaccination, strategies that involved vaccinating girls aged 9–14 years with two doses were predicted to be the most efficient and cost-effective in all four LMICs. NNV ranged from 78 to 381 and ICER ranged from $28 per DALY averted to $1406 per DALY averted depending on the country. The most efficient and cost-effective strategies were routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with a 5-year extended interval between doses and a catch-up programme at age 14 years. Vaccinating boys (aged 9–14 years) or women aged 18 years or older resulted in substantially higher NNVs and ICERs. Interpretation We identified two strategies that could maximise efforts to prevent cervical cancer in LMICs given constraints on vaccine supplies and costs and that would allow a maximum of LMICs to introduce HPV vaccination. Funding World Health Organization, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, PATH, and The Bill & Melinda Gates Foundation. Translations For the French and Spanish translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | | | - Dave Martin
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK; School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Élodie Bénard
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Guillaume Gingras
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Marie-Claude Boily
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | | | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| |
Collapse
|
29
|
Clapham H, Gad M, Gheorghe A, Hutubessy R, Megiddo I, Painter C, Ruiz F, Cheikh N, Gorgens M, Wilkinson T, Brisson M, Gay N, Labadin J, McVernon J, Luz PM, Ndifon W, Nichols BE, Prinja S, Salomon J, Tshangela A. Assessing fitness-for-purpose and comparing the suitability of COVID-19 multi-country models for local contexts and users. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13224.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Mathematical models have been used throughout the COVID-19 pandemic to inform policymaking decisions. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was established to provide country governments, particularly low- and middle-income countries (LMICs), and other model users with an overview of the aims, capabilities and limits of the main multi-country COVID-19 models to optimise their usefulness in the COVID-19 response. Methods: Seven models were identified that satisfied the inclusion criteria for the model comparison and had creators that were willing to participate in this analysis. A questionnaire, extraction tables and interview structure were developed to be used for each model, these tools had the aim of capturing the model characteristics deemed of greatest importance based on discussions with the Policy Group. The questionnaires were first completed by the CMCC Technical group using publicly available information, before further clarification and verification was obtained during interviews with the model developers. The fitness-for-purpose flow chart for assessing the appropriateness for use of different COVID-19 models was developed jointly by the CMCC Technical Group and Policy Group. Results: A flow chart of key questions to assess the fitness-for-purpose of commonly used COVID-19 epidemiological models was developed, with focus placed on their use in LMICs. Furthermore, each model was summarised with a description of the main characteristics, as well as the level of engagement and expertise required to use or adapt these models to LMIC settings. Conclusions: This work formalises a process for engagement with models, which is often done on an ad-hoc basis, with recommendations for both policymakers and model developers and should improve modelling use in policy decision making.
Collapse
|
30
|
Stenberg K, Watts R, Bertram MY, Engesveen K, Maliqi B, Say L, Hutubessy R. Cost-Effectiveness of Interventions to Improve Maternal, Newborn and Child Health Outcomes: A WHO-CHOICE Analysis for Eastern Sub-Saharan Africa and South-East Asia. Int J Health Policy Manag 2021; 10:706-723. [PMID: 33904699 PMCID: PMC9278381 DOI: 10.34172/ijhpm.2021.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 01/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Information on cost-effectiveness allows policy-makers to evaluate if they are using currently available resources effectively and efficiently. Our objective is to examine the cost-effectiveness of health interventions to improve maternal, newborn and child health (MNCH) outcomes, to provide global evidence relative to the context of two geographic regions.
Methods: We consider interventions across the life course from adolescence to pregnancy and for children up to 5 years old. Interventions included are those that fall within the areas of immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST). Generalized cost-effectiveness analysis (GCEA) was used to derive average cost-effectiveness ratios (ACERs) for individual interventions and combinations (packages). Costs were assessed from the health system perspective and reported in international dollars. Health outcomes were estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. The model was run for 2 regions: Eastern sub-Saharan Africa (SSA-E) and South-East Asia (SEA).
Results: The World Health Organization (WHO) recommended interventions to improve MNCH are generally considered cost-effective, with the majority of interventions demonstrating ACERs below I$100/HLY saved in the chosen settings (low-and middle-income countries [LMICs]). Best performing interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. ACERs below I$100 can be found across all delivery platforms, from community to hospital level. The combination of interventions into packages (such as antenatal care) produces favorable ACERs.
Conclusion: Within each region there are interventions which represent very good value for money. There are opportunities to gear investments towards high-impact interventions and packages for MNCH outcomes. Cost-effectiveness tools can be used at national level to inform investment cases and overall priority setting processes.
Collapse
Affiliation(s)
- Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
| | - Rory Watts
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Melanie Y Bertram
- Department of Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
| | - Kaia Engesveen
- Department of Nutrition for Health and Development, World Health Organization (WHO), Geneva, Switzerland
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
| |
Collapse
|
31
|
Xia C, Xu X, Zhao X, Hu S, Qiao Y, Zhang Y, Hutubessy R, Basu P, Broutet N, Jit M, Zhao F. Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study. BMC Med 2021; 19:62. [PMID: 33653331 PMCID: PMC7927373 DOI: 10.1186/s12916-021-01930-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions. METHODS A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty. RESULTS The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year. CONCLUSIONS By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.
Collapse
Affiliation(s)
- Changfa Xia
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Xiaoqian Xu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Xuelian Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Shangying Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Youlin Qiao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Yong Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Nathalie Broutet
- Department of Reproductive Health and Research - WHO Special Research Programme on Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing, 100021, China.
| |
Collapse
|
32
|
Edoka I, Kohli-Lynch C, Fraser H, Hofman K, Tempia S, McMorrow M, Ramkrishna W, Lambach P, Hutubessy R, Cohen C. A cost-effectiveness analysis of South Africa's seasonal influenza vaccination programme. Vaccine 2020; 39:412-422. [PMID: 33272702 DOI: 10.1016/j.vaccine.2020.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/02/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Seasonal influenza imposes a significant health and economic burden in South Africa, particularly in populations vulnerable to severe consequences of influenza. This study assesses the cost-effectiveness of South Africa's seasonal influenza vaccination strategy, which involves vaccinating vulnerable populations with trivalent inactivated influenza vaccine (TIV) during routine facility visits. Vulnerable populations included in our analysis are persons aged ≥ 65 years; pregnant women; persons living with HIV/AIDS (PLWHA), persons of any age with underlying medical conditions (UMC) and children aged 6-59 months. METHOD We employed the World Health Organisation's (WHO) Cost Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV), a decision tree model, to evaluate the 2018 seasonal influenza vaccination campaign from a public healthcare provider and societal perspective. CETSIV was populated with existing country-specific demographic, epidemiologic and coverage data to estimate incremental cost-effectiveness ratios (ICERs) by comparing costs and benefits of the influenza vaccination programme to no vaccination. RESULTS The highest number of clinical events (influenza cases, outpatient visits, hospitalisation and deaths) were averted in PLWHA and persons with other UMCs. Using a cost-effectiveness threshold of US$ 3400 per quality-adjusted life year (QALY), our findings suggest that the vaccination programme is cost-effective for all vulnerable populations except for children aged 6-59 months. ICERs ranged from ~US$ 1 750 /QALY in PLWHA to ~US$ 7500/QALY in children. In probabilistic sensitivity analyses, the vaccination programme was cost-effective in pregnant women, PLWHA, persons with UMCs and persons aged ≥65 years in >80% of simulations. These findings were robust to changes in many model inputs but were most sensitive to uncertainty in estimates of influenza-associated illness burden. CONCLUSION South Africa's seasonal influenza vaccination strategy of opportunistically targeting vulnerable populations during routine visits is cost-effective. A budget impact analysis will be useful for supporting future expansions of the programme.
Collapse
Affiliation(s)
- Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather Fraser
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Duluth, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; US Public Health Service, Rockville, MD, USA
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
33
|
Botwright S, Kahn AL, Hutubessy R, Lydon P, Biey J, Karim Sidibe A, Diarra I, Nadjib M, Suwantika AA, Setiawan E, Archer R, Kristensen D, Menozzi-Arnaud M, Mpia Bwaka A, Mwenda JM, Giersing BK. How can we evaluate the potential of innovative vaccine products and technologies in resource constrained settings? A total systems effectiveness (TSE) approach to decision-making. Vaccine X 2020; 6:100078. [PMID: 33196036 PMCID: PMC7644745 DOI: 10.1016/j.jvacx.2020.100078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/14/2020] [Accepted: 10/04/2020] [Indexed: 11/04/2022] Open
Abstract
Innovations in vaccine product attributes could play an important role in addressing coverage and equity (C&E) gaps, but there is currently a poor understanding of the full system impact and trade-offs associated with investing in such technologies, both from the perspective of national immunisation programmes (NIPs) and vaccine developers. Total Systems Effectiveness (TSE) was developed as an approach to evaluate vaccines with different product attributes from a systems perspective, in order to analyse and compare the value of innovative vaccine products in different settings. The TSE approach has been advanced over the years by various stakeholders including the Bill and Melinda Gates Foundation (BMGF), Gavi, PATH, UNICEF and WHO. WHO further developed the TSE approach to incorporate the country perspective into immunisation decision-making, in order for countries to evaluate innovative products for introduction and product switch decisions, and for vaccine development stakeholders to conduct their assessments of product value in line with country preferences. This paper describes the original TSE approach, development of the tool and processes for NIPs to apply the WHO TSE approach, and results from piloting in 12 countries across Africa, Asia and the Americas. The WHO TSE framework emerged from this piloting effort. The WHO TSE approach has been welcomed by NIP and vaccine development stakeholders as a useful tool to evaluate trade-offs between different products. It was emphasised that the concept of “total systems effectiveness” is likely to be context-specific and that TSE is valuable in facilitating a deliberative process to articulate NIP priorities, for decisions around product choice, and for prioritising the development of future vaccine innovations.
Collapse
Affiliation(s)
- Siobhan Botwright
- Department of Immunization, Vaccines & Biologicals, World Health Organization Headquarters, 20 Avenue Appia, 1211-CH 27 Geneva, Switzerland
| | - Anna-Lea Kahn
- Department of Immunization, Vaccines & Biologicals, World Health Organization Headquarters, 20 Avenue Appia, 1211-CH 27 Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines & Biologicals, World Health Organization Headquarters, 20 Avenue Appia, 1211-CH 27 Geneva, Switzerland
| | - Patrick Lydon
- Department of Immunization, Vaccines & Biologicals, World Health Organization Headquarters, 20 Avenue Appia, 1211-CH 27 Geneva, Switzerland
| | - Joseph Biey
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Abdoul Karim Sidibe
- WHO Country Office for Mali (OMS/MALI), Quartier Ntomiboro-Bougou, B.P. 99, Bamako, Mali
| | - Ibrahima Diarra
- Direction Générale de la Santé et de l'Hygiène Publique, Cité Administrative Bamako, Bamako BP 232, Mali
| | - Mardiati Nadjib
- Health Financing Activity, United States Agency for International Development (USAID), Daerah Khusus Ibukota Jakarta 10110, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Indonesia Jl. Raya Bandung-Sumedang Km. 21 Jatinangor, Sumedang, West Java 45363, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Indonesia Jl. Raya Bandung-Sumedang Km. 21 Jatinangor, Sumedang, West Java 45363, Indonesia
| | - Ery Setiawan
- Health Financing Activity, United States Agency for International Development (USAID), Daerah Khusus Ibukota Jakarta 10110, Indonesia
| | - Rachel Archer
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Muang, Nonthaburi 11000, Thailand
| | | | - Marion Menozzi-Arnaud
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand, Saconnex, Geneva, Switzerland
| | - Ado Mpia Bwaka
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Jason M Mwenda
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Birgitte K Giersing
- Department of Immunization, Vaccines & Biologicals, World Health Organization Headquarters, 20 Avenue Appia, 1211-CH 27 Geneva, Switzerland
| |
Collapse
|
34
|
Lack A, Hiligsmann M, Bloem P, Tünneßen M, Hutubessy R. Parent, provider and vaccinee preferences for HPV vaccination: A systematic review of discrete choice experiments. Vaccine 2020; 38:7226-7238. [PMID: 33023774 DOI: 10.1016/j.vaccine.2020.08.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/11/2020] [Accepted: 08/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To systematically review, appraise and evaluate available evidence regarding discrete-choice experiments (DCEs) for the human papilloma virus (HPV) vaccination in order to support policymakers in making reasonable and effective vaccination program implementation decisions. METHODS A systematic literature review was conducted using the databases PubMed and Embase for DCEs in HPV up to May 2019. Extracted data was tabulated and two checklists were used for the quality appraisal of the included studies. All attributes were categorized in outcome, process or costs attributes and the relative importance of attributes was calculated using the range method. RESULTS Out of 164 identified studies, 12 met the inclusion criteria. Eight were from high income countries (HICs) and four from low and middle-income countries (LMICs). Five studies each examined vaccinee and parent preferences, while only two assessed the providers' preferences. The studies were rather heterogenous in terms of the populations investigated, the attributes included and the methodologic approach. Overall, outcome measures were the most prominent attributes and effectiveness consistently yielded high relative importance scores. But also process factors, such as the age at vaccination, played an important role for decision making. Discrepancies between HICs and LMICs were most prominent for cost attributes. CONCLUSION The heterogenous preferences this review elicited highlight the importance of context when making decisions grounded on consumer preferences. Especially the lack of evidence from LMICs, where the burden of cervical cancer is highest, is worrisome. In order to increase uptake, close vaccination gaps and reduce current inequities in (reproductive) healthcare, policy makers need to understand the features that drive individual vaccination decisions and adapt national and clinical guidelines accordingly. Future research therefore needs to focus on LMICs in order to elicit preferences of those most vulnerable populations.
Collapse
Affiliation(s)
- Alina Lack
- Department for Immunization, Vaccination and Biologicals, WHO Avenue Appia 20, 1202 Geneva, Switzerland.
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Duboisdomein 30, 6229 Maastricht, Netherlands
| | - Paul Bloem
- Department for Immunization, Vaccination and Biologicals, WHO Avenue Appia 20, 1202 Geneva, Switzerland
| | - Maike Tünneßen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 Maastricht, Netherlands
| | - Raymond Hutubessy
- Department for Immunization, Vaccination and Biologicals, WHO Avenue Appia 20, 1202 Geneva, Switzerland.
| |
Collapse
|
35
|
Procter SR, Salman O, Pecenka C, Gonçalves BP, Paul P, Hutubessy R, Lambach P, Lawn JE, Jit M. A review of the costs of delivering maternal immunisation during pregnancy. Vaccine 2020; 38:6199-6204. [PMID: 32753292 PMCID: PMC7482437 DOI: 10.1016/j.vaccine.2020.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 01/18/2023]
Abstract
Background Routine maternal immunisation against influenza and pertussis are recommended by the WHO to protect mother and child, and new vaccines are under development. Introducing maternal vaccines into national programmes requires an understanding of vaccine delivery costs – particularly in low resource settings. Methods We searched Medline, Embase, Econlit, and Global Health for studies reporting costs of delivering vaccination during pregnancy but excluded studies that did not separate the vaccine purchase price. Extracted costs were inflated and converted to 2018 US dollars. Results Sixteen studies were included, of which two used primary data to estimate vaccine delivery costs. Costs per dose ranged from $0.55 to $0.64 in low-income countries, from $1.25 to $6.55 for middle-income countries, and from $5.76 to $39.87 in high-income countries. Conclusions More research is needed on the costs of delivering maternal immunisation during pregnancy, and of integrating vaccine delivery into existing programmes of antenatal care especially in low and middle-income countries.
Collapse
Affiliation(s)
- Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Omar Salman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States.
| | - Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Modelling and Economics Unit, Public Health England, London, United Kingdom; School of Public Health, University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
36
|
Taychakhoonavudh S, Chumchujan W, Hutubessy R, Chaiyakunapruk N. Landscape of vaccine access and health technology assessment role in decision-making process in ASEAN countries. Hum Vaccin Immunother 2020; 16:1728-1737. [PMID: 32574124 PMCID: PMC7482843 DOI: 10.1080/21645515.2020.1769388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Over the past few years, many innovative vaccines became available that offer protection for diseases which have never been prevented before. While there are several factors that could have an impact on access, the use of health technology assessment (HTA) undoubtedly is also one of the contributing factors. Objectives: To explore the landscape of vaccine access and the role of HTA in new vaccine adoption in Association of Southeast Asian Nations (ASEAN) countries. Results: A great deal of progress has been made in terms of access to new and innovation vaccine in the region. Variation in access to these vaccines comparing between countries, however, is still observed. The use of HTA in supporting new vaccine adoption is still in an early stage especially in Gavi, the Vaccine Alliance-eligible countries. Conclusions: Improving the use of HTA evidences to support decision making could accelerate the efficient adoption of new vaccine in ASEAN region.
Collapse
Affiliation(s)
- Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Woralak Chumchujan
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| |
Collapse
|
37
|
Prudden HJ, Hasso-Agopsowicz M, Black RE, Troeger C, Reiner RC, Breiman RF, Jit M, Kang G, Lamberti L, Lanata CF, Lopman BA, Ndifon W, Pitzer VE, Platts-Mills JA, Riddle MS, Smith PG, Hutubessy R, Giersing B. Meeting Report: WHO Workshop on modelling global mortality and aetiology estimates of enteric pathogens in children under five. Cape Town, 28-29th November 2018. Vaccine 2020; 38:4792-4800. [PMID: 32253097 PMCID: PMC7306158 DOI: 10.1016/j.vaccine.2020.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline. The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based. Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.
Collapse
Affiliation(s)
- H J Prudden
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - M Hasso-Agopsowicz
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - R E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R F Breiman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - M Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, National Infections Service, Public Health England, United Kingdom; School of Public Health, University of Hong Kong, Hong Kong
| | - G Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - L Lamberti
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - C F Lanata
- Instituto de Investigacion Nutricional, Lima, Peru; Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN 37027, USA
| | - B A Lopman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - W Ndifon
- African Institute for Mathematical Sciences, Cape Town, South Africa
| | - V E Pitzer
- Department of Epidemiology and Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - J A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - M S Riddle
- Uniformed Services University, Bethesda, MD 120814, USA
| | - P G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - R Hutubessy
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - B Giersing
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland.
| |
Collapse
|
38
|
Gebreselassie N, Hutubessy R, Vekemans J, den Boon S, Kasaeva T, Zignol M. The case for assessing the full value of new tuberculosis vaccines. Eur Respir J 2020; 55:55/3/1902414. [PMID: 32198269 DOI: 10.1183/13993003.02414-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Raymond Hutubessy
- Dept of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Johan Vekemans
- Dept of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Saskia den Boon
- Dept of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Tereza Kasaeva
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Matteo Zignol
- Global TB Programme, World Health Organization, Geneva, Switzerland
| |
Collapse
|
39
|
Gultekin M, Ramirez PT, Broutet N, Hutubessy R. World Health Organization call for action to eliminate cervical cancer globally. Int J Gynecol Cancer 2020; 30:426-427. [DOI: 10.1136/ijgc-2020-001285] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
|
40
|
Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, Martin D, Simms KT, Bénard É, Boily MC, Sy S, Regan C, Keane A, Caruana M, Nguyen DTN, Smith MA, Laprise JF, Jit M, Alary M, Bray F, Fidarova E, Elsheikh F, Bloem PJN, Broutet N, Hutubessy R. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 2020; 395:575-590. [PMID: 32007141 PMCID: PMC7043009 DOI: 10.1016/s0140-6736(20)30068-4] [Citation(s) in RCA: 344] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.
Collapse
Affiliation(s)
- Marc Brisson
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada; Department of Social and Preventive Medicine, Universite Laval, Québec, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada
| | - Guillaume Gingras
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Dave Martin
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Élodie Bénard
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada
| | - Marie-Claude Boily
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada; Department of Social and Preventive Medicine, Universite Laval, Québec, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Catherine Regan
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Adam Keane
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Diep T N Nguyen
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK; School of Public Health, University of Hong Kong, Hong Kong, China
| | - Michel Alary
- Centre de recherche du CHU de Québec - Universite Laval, Québec, QC, Canada; Department of Social and Preventive Medicine, Universite Laval, Québec, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Elena Fidarova
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Fayad Elsheikh
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul J N Bloem
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
41
|
Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, Burger EA, Martin D, Nguyen DTN, Bénard É, Sy S, Regan C, Drolet M, Gingras G, Laprise JF, Torode J, Smith MA, Fidarova E, Trapani D, Bray F, Ilbawi A, Broutet N, Hutubessy R. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 2020; 395:591-603. [PMID: 32007142 PMCID: PMC7043006 DOI: 10.1016/s0140-6736(20)30157-4] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90-70-90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality from non-communicable diseases by 2030. METHODS The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10-14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions. FINDINGS In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9-14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1-0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3-37·8), averting 300 000 (300 000-400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4-66·1), averting 4·8 million (4·1-4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0-89·3), averting 13·3 million (13·1-13·6) deaths (with once-lifetime screening), or by 92·3% (88·4-93·0), averting 14·6 million (14·1-14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6-89·9), averting 45·8 million (44·7-46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0-98·0), averting 60·8 million (60·2-61·2) deaths (with once-lifetime screening), or by 98·6% (96·5-98·6), averting 62·6 million (62·1-62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45-55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29-34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30-69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4-37·9) by 2030, 96·2% (94·3-96·8) by 2070, and 98·6% (96·9-98·8) by 2120. INTERPRETATION These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives. FUNDING WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec-Santé.
Collapse
Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Jane J Kim
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Adam Keane
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Emily A Burger
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Dave Martin
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Diep T N Nguyen
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Élodie Bénard
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Stephen Sy
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Catherine Regan
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Guillaume Gingras
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | | | - Julie Torode
- Union for International Cancer Control, Geneva, Switzerland
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Elena Fidarova
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Dario Trapani
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
42
|
Gottlieb SL, Giersing B, Boily MC, Chesson H, Looker KJ, Schiffer J, Spicknall I, Hutubessy R, Broutet N. Modelling efforts needed to advance herpes simplex virus (HSV) vaccine development: Key findings from the World Health Organization Consultation on HSV Vaccine Impact Modelling. Vaccine 2019; 37:7336-7345. [PMID: 28647165 PMCID: PMC10599163 DOI: 10.1016/j.vaccine.2017.03.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/09/2017] [Accepted: 03/23/2017] [Indexed: 12/28/2022]
Abstract
Development of a vaccine against herpes simplex virus (HSV) is an important goal for global sexual and reproductive health. In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in 2015 the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling. The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine. This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters.
Collapse
Affiliation(s)
| | | | | | - Harrell Chesson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | - Ian Spicknall
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | |
Collapse
|
43
|
Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biological, World Health Organization, 20 Avenue Appia, 01210 Geneva, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 01210 Geneva, Switzerland
| |
Collapse
|
44
|
Xia C, Hu S, Xu X, Zhao X, Qiao Y, Broutet N, Canfell K, Hutubessy R, Zhao F. Projections up to 2100 and a budget optimisation strategy towards cervical cancer elimination in China: a modelling study. The Lancet Public Health 2019; 4:e462-e472. [DOI: 10.1016/s2468-2667(19)30162-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 12/29/2022]
|
45
|
den Boon S, Jit M, Brisson M, Medley G, Beutels P, White R, Flasche S, Hollingsworth TD, Garske T, Pitzer VE, Hoogendoorn M, Geffen O, Clark A, Kim J, Hutubessy R. Guidelines for multi-model comparisons of the impact of infectious disease interventions. BMC Med 2019; 17:163. [PMID: 31422772 PMCID: PMC6699075 DOI: 10.1186/s12916-019-1403-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the increasing popularity of multi-model comparison studies and their ability to inform policy recommendations, clear guidance on how to conduct multi-model comparisons is not available. Herein, we present guidelines to provide a structured approach to comparisons of multiple models of interventions against infectious diseases. The primary target audience for these guidelines are researchers carrying out model comparison studies and policy-makers using model comparison studies to inform policy decisions. METHODS The consensus process used for the development of the guidelines included a systematic review of existing model comparison studies on effectiveness and cost-effectiveness of vaccination, a 2-day meeting and guideline development workshop during which mathematical modellers from different disease areas critically discussed and debated the guideline content and wording, and several rounds of comments on sequential versions of the guidelines by all authors. RESULTS The guidelines provide principles for multi-model comparisons, with specific practice statements on what modellers should do for six domains. The guidelines provide explanation and elaboration of the principles and practice statements as well as some examples to illustrate these. The principles are (1) the policy and research question - the model comparison should address a relevant, clearly defined policy question; (2) model identification and selection - the identification and selection of models for inclusion in the model comparison should be transparent and minimise selection bias; (3) harmonisation - standardisation of input data and outputs should be determined by the research question and value of the effort needed for this step; (4) exploring variability - between- and within-model variability and uncertainty should be explored; (5) presenting and pooling results - results should be presented in an appropriate way to support decision-making; and (6) interpretation - results should be interpreted to inform the policy question. CONCLUSION These guidelines should help researchers plan, conduct and report model comparisons of infectious diseases and related interventions in a systematic and structured manner for the purpose of supporting health policy decisions. Adherence to these guidelines will contribute to greater consistency and objectivity in the approach and methods used in multi-model comparisons, and as such improve the quality of modelled evidence for policy.
Collapse
Affiliation(s)
- Saskia den Boon
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- School of Public Health, University of Hong Kong, Hong Kong, SAR China
| | - Marc Brisson
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Graham Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Richard White
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- TB Modelling Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Tini Garske
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT 06511 USA
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Oliver Geffen
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Kim
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| |
Collapse
|
46
|
Riewpaiboon A, Pathammavong C, Fox K, Hutubessy R. Cost analysis of pilot school-based HPV vaccination program in two provinces of Lao PDR. ACTA ACUST UNITED AC 2019. [DOI: 10.29090/psa.2019.01.017.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
47
|
Mauskopf J, Standaert B, Connolly MP, Culyer AJ, Garrison LP, Hutubessy R, Jit M, Pitman R, Revill P, Severens JL. Economic Analysis of Vaccination Programs: An ISPOR Good Practices for Outcomes Research Task Force Report. Value Health 2018; 21:1133-1149. [PMID: 30314613 DOI: 10.1016/j.jval.2018.08.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/16/2018] [Indexed: 05/21/2023]
Abstract
This report provides recommendations for budget holders and decision makers in high-, middle, and low-income countries requiring economic analyses of new vaccination programs to allocate scarce resources given budget constraints. ISPOR's Economic Evaluation of Vaccines Designed to Prevent Infectious Disease: Good Practices Task Force wrote guidelines for three analytic methods and solicited comments on them from external reviewers. Cost-effectiveness analyses use decision-analytic models to estimate cumulative changes in resource use, costs, and changes in quality- or disability-adjusted life-years attributable to changes in disease outcomes. Constrained optimization modeling uses a mathematical objective function to be optimized (e.g. disease cases avoided) for a target population for a set of interventions including vaccination programs within established constraints. Fiscal health modeling estimates changes in net present value of government revenues and expenditures attributable to changes in disease outcomes. The task force recommends that those designing economic analyses for new vaccination programs take into account the decision maker's policy objectives and country-specific decision context when estimating: uptake rate in the target population; vaccination program's impact on disease cases in the population over time using a dynamic transmission epidemiologic model; vaccination program implementation and operating costs; and the changes in costs and health outcomes of the target disease(s). The three approaches to economic analysis are complementary and can be used alone or together to estimate a vaccination program's economic value for national, regional, or subregional decision makers in high-, middle-, and low-income countries.
Collapse
Affiliation(s)
| | | | - Mark P Connolly
- University of Groningen, Groningen, The Netherlands; Global Market Access Solutions LLC, Geneva, Switzerland
| | | | - Louis P Garrison
- Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and Public Health, London, UK
| | | | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Johan L Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
48
|
Drolet M, Bénard É, Jit M, Hutubessy R, Brisson M. Model Comparisons of the Effectiveness and Cost-Effectiveness of Vaccination: A Systematic Review of the Literature. Value Health 2018; 21:1250-1258. [PMID: 30314627 DOI: 10.1016/j.jval.2018.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/20/2018] [Accepted: 03/25/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To describe all published articles that have conducted comparisons of model-based effectiveness and cost-effectiveness results in the field of vaccination. Specific objectives were to 1) describe the methodologies used and 2) identify the strengths and limitations of the studies. METHODS We systematically searched MEDLINE and Embase databases for studies that compared predictions of effectiveness and cost-effectiveness of vaccination of two or more mathematical models. We categorized studies into two groups on the basis of their data source for comparison (previously published results or new simulation results) and performed a qualitative synthesis of study conclusions. RESULTS We identified 115 eligible articles (only 5% generated new simulations from the reviewed models) examining the effectiveness and cost-effectiveness of vaccination against 14 pathogens (69% of studies examined human papillomavirus, influenza, and/or pneumococcal vaccines). The goal of most of studies was to summarize evidence for vaccination policy decisions, and cost-effectiveness was the most frequent outcome examined. Only 33%, 25%, and 3% of studies followed a systematic approach to identify eligible studies, assessed the quality of studies, and performed a quantitative synthesis of results, respectively. A greater proportion of model comparisons using published studies followed a systematic approach to identify eligible studies and to assess their quality, whereas more studies using new simulations performed quantitative synthesis of results and identified drivers of model conclusions. Most comparative modeling studies concluded that vaccination was cost-effective. CONCLUSIONS Given the variability in methods used to conduct/report comparative modeling studies, guidelines are required to enhance their quality and transparency and to provide better tools for decision making.
Collapse
Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | | | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada; Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
| |
Collapse
|
49
|
Ng SS, Hutubessy R, Chaiyakunapruk N. Systematic review of cost-effectiveness studies of human papillomavirus (HPV) vaccination: 9-Valent vaccine, gender-neutral and multiple age cohort vaccination. Vaccine 2018; 36:2529-2544. [PMID: 29625764 DOI: 10.1016/j.vaccine.2018.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The success of human papillomavirus (HPV) national immunization program depends on effective strategies in optimizing the uptake of HPV vaccine. Given the increasing number of economic evaluations, this review was conducted to update the economic evidence on HPV vaccination, by focusing on: (i) 9-valent vaccine compared to bi- or quadrivalent vaccine; (ii) gender-neutral vaccination compared to female only vaccination; and (iii) multiple age cohort immunization compared to single age cohort immunization. METHODS Searches were performed until June 2016 using 4 databases: PubMed; Embase; Cochrane Library; and LILACS. The combined WHO, Drummond and CHEERS checklist were used to evaluate the quality of included studies. RESULTS Thirty-four studies were included in the review and most of them were conducted in high-income countries. The inclusion of adolescent boys in vaccination program was found to be cost-effective if vaccine price and coverage was low. When coverage for female was above 75%, gender-neutral vaccination was less cost-effective than when targeting only girls aged 9-18 years. Current evidence does not show conclusive proof of greater cost-effectiveness of 9-valent vaccine compared to the older HPV vaccines as the price for 9-valent vaccine was still uncertain. Multicohort immunization strategy was cost-effective in the age range 9-14 years but the upper age limit at which vaccination was no longer cost-effective needs to be further investigated. Key influential parameters identified were duration of vaccine protection, vaccine price, coverage, and discounting rates. CONCLUSIONS These findings are expected to support policy-makers in making recommendations for HPV immunization programs on either switching to the 9-valent vaccine or inclusion of adolescent boys' vaccination or extending the age of vaccination.
Collapse
Affiliation(s)
- Siok Shen Ng
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy, Hospital Melaka, Melaka, Malaysia
| | - Raymond Hutubessy
- World Health Organization, Initiative for Vaccine Research, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
| |
Collapse
|
50
|
Pecenka C, Munthali S, Chunga P, Levin A, Morgan W, Lambach P, Bhat N, Neuzil KM, Ortiz JR, Hutubessy R. Maternal influenza immunization in Malawi: Piloting a maternal influenza immunization program costing tool by examining a prospective program. PLoS One 2017; 12:e0190006. [PMID: 29281710 PMCID: PMC5744963 DOI: 10.1371/journal.pone.0190006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This costing study in Malawi is a first evaluation of a Maternal Influenza Immunization Program Costing Tool (Costing Tool) for maternal immunization. The tool was designed to help low- and middle-income countries plan for maternal influenza immunization programs that differ from infant vaccination programs because of differences in the target population and potential differences in delivery strategy or venue. METHODS This analysis examines the incremental costs of a prospective seasonal maternal influenza immunization program that is added to a successful routine childhood immunization and antenatal care program. The Costing Tool estimates financial and economic costs for different vaccine delivery scenarios for each of the major components of the expanded immunization program. RESULTS In our base scenario, which specifies a donated single dose pre-filled vaccine formulation, the total financial cost of a program that would reach 2.3 million women is approximately $1.2 million over five years. The economic cost of the program, including the donated vaccine, is $10.4 million over the same period. The financial and economic costs per immunized pregnancy are $0.52 and $4.58, respectively. Other scenarios examine lower vaccine uptake, reaching 1.2 million women, and a vaccine purchased at $2.80 per dose with an alternative presentation. CONCLUSION This study estimates the financial and economic costs associated with a prospective maternal influenza immunization program in a low-income country. In some scenarios, the incremental delivery cost of a maternal influenza immunization program may be as low as some estimates of childhood vaccination programs, assuming the routine childhood immunization and antenatal care systems are capable of serving as the platform for an additional vaccination program. However, purchasing influenza vaccines at the prices assumed in this analysis, instead of having them donated, is likely to be challenging for lower-income countries. This result should be considered as a starting point to understanding the costs of maternal immunization programs in low- and middle-income countries.
Collapse
Affiliation(s)
- Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America
| | | | | | - Ann Levin
- Levin and Morgan, Washington, DC, United States of America
| | - Win Morgan
- Levin and Morgan, Washington, DC, United States of America
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America
| | - Kathleen M. Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Justin R. Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
- * E-mail:
| |
Collapse
|