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Economic evaluation of Haemophilus influenzae type b vaccination in Moscow, Russian Federation
A E Platonov1, U K Griffiths, M V Voeykova
1Central Institute of Epidemiology, Novogireevskaya Street, 3a, Moscow 111123, Russian Federation. platonov@pcr.ru
Insights
The Haemophilus influenzae type b (Hib) vaccine is not cost-effective in Moscow due to low disease incidence and treatment costs. Even at $5 per dose, the vaccine
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Haemophilus influenzae type b (Hib) meningitis poses a public health concern globally.
- Estimating the economic impact of Hib meningitis and the value of vaccination is crucial for resource allocation.
Purpose of the Study:
- To assess the cost-effectiveness of introducing the Hib vaccine into routine immunization services in Moscow.
- To determine the economic viability of Hib vaccination in a specific urban setting.
Main Methods:
- Prospective surveillance for Hib meningitis incidence in children under 5 in Moscow (Oct 1999-Sep 2001).
- Collection of treatment costs for acute cases and assessment of sequelae costs.
- Estimation of Hib vaccination costs assuming a $5/dose price, 4-dose schedule, and 97% coverage.
Main Results:
- Annual incidence of Hib meningitis was 5.7 per 100,000 children <5 years.
- Average treatment cost per case was $1296; additional lifetime cost for sequelae was $15,820.
- Cost-effectiveness ratios were $77,503 per averted case and $10,842 per DALY averted; break-even vaccine price was very low.
Conclusions:
- Hib meningitis incidence is low in Moscow.
- Medical treatment costs for Hib meningitis are relatively inexpensive.
- The Hib vaccine at $5 per dose is not currently a cost-effective intervention in Moscow.
Objective:
To estimate the cost-effectiveness of providing Haemophilus influenzae type b (Hib) vaccine to children in Moscow in routine immunization services.
Methods:
The incidence of Hib meningitis among children aged <5 years in Moscow was obtained from a prospective surveillance study undertaken during October 1999-September 2001, with treatment cost data collected for all cases. Sequelae in surviving children were assessed in December 2002. The costs of Hib vaccination in Moscow were estimated assuming a vaccine price of US dollar 5 per dose and the same four-dose schedule and 97% coverage as for diphtheria-tetanus-pertussis vaccine. The most uncertain variables were varied in a sensitivity analysis.
Results:
The annual incidence of Hib meningitis was 5.7 per 100,000 children <5 years. The average treatment cost for an acute Hib meningitis case was US dollar 1296. For a patient with sequelae, the average additional lifetime discounted treatment cost was US dollar 15,820. The total annual cost of Hib vaccination of infants in Moscow was estimated as US dollar 1.5 million per year. In the base case analysis, the cost-effectiveness ratios amount to US dollar 77,503 per Hib meningitis case averted and US dollar 10,842 per discounted disability adjusted life year averted. The break-even vaccine price, where the annual vaccination costs equal annual treatment costs averted, is only US dollar 0.04 per dose in the base case scenario. If discounted indirect costs are included, the break-even vaccine price is US dollar 0.5 per dose.
Conclusion:
In Moscow, the incidence of Hib meningitis is low and the costs of hospitalization and subsequent medical treatment are relatively inexpensive. Given these factors, Hib vaccine at US dollar 5 per dose would not be a cost-effective option in Moscow at the present time.
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