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Economic evaluation of universal BCG vaccination of Japanese infants
M Rahman1, M Sekimoto, I Takamatsu
1Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Insights
Universal BCG vaccination for infants in Japan is costly, with high expenses to prevent one tuberculosis case. The cost-effectiveness depends heavily on vaccine efficacy and protection duration.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Investigates the international debate on Bacillus Calmette-Guérin (BCG) vaccine efficacy.
- Addresses the low incidence of tuberculosis (TB) in Japanese children.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of universal BCG vaccination versus no vaccination in Japan.
- To evaluate the economic impact of a BCG vaccination program for infants.
Main Methods:
- A hypothetical cohort of 1.2 million infants born in Japan in 1996 was modeled.
- Calculated TB cases prevented, immunizations needed, and costs using assumed vaccine efficacy (40-80%) and 10-year protection.
- Performed sensitivity analyses on duration of protection, TB incidence, vaccine coverage, and discount rate.
Main Results:
- Estimated 111-542 TB cases, including 10-27 TB-meningitis cases, prevented over 10 years.
- Cost to prevent one TB case ranged from US$35,950-175,862, requiring 2125-10,399 immunizations.
- Cost per TB case averted is sensitive to BCG protection duration and TB incidence.
Conclusions:
- The cost per TB case prevented by BCG vaccination is high, influenced by vaccine efficacy and protection duration.
- This cost is considerable when compared to the cost of treating an individual TB case.
Background:
The international controversy surrounding the use and effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine and the low incidence of tuberculosis (TB) among Japanese children prompted this study.
Methods:
We compared 'universal BCG vaccination' with 'no vaccination at all' using a cost-effectiveness analysis. The study population was a hypothetical cohort comprising a total of 1.2 million infants born in 1996 at locations all over Japan. A model was developed to calculate the number of TB cases prevented by the vaccination programme. Assuming 40-80% overall vaccine efficacy (64-86% for TB-meningitis) and 10 years of protection, we calculated the cost and number of immunizations required to prevent one child from developing TB, the total number of TB cases averted by vaccination and total costs required for the programme.
Results:
Based on an assumption of flexible vaccine efficacy (40-80%), we estimated that 111-542 TB cases including 10-27 of TB-meningitis would be prevented during the 10 years after BCG vaccination among the cohort of infants born in 1996. About US$35 950-175 862 or 2125-10 399 immunizations would be required to prevent one child from developing TB. Sensitivity analyses covering a wide duration of protection, incidence of TB, vaccine coverage and discount rate, revealed that other than vaccine efficacy, the cost of preventing a single case of TB is highly sensitive to the duration of BCG protection and TB incidence.
Conclusion:
The cost per case of TB prevented is heavily dependent on vaccine efficacy and the duration of protection, and is high compared with the cost of treating one child who has developed TB.