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Evaluating the neonatal BCG vaccination programme in Ireland
Cara Usher1, Roisin Adams1, Susanne Schmitz2
1National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland.
Insights
A selective BCG vaccination strategy for infants is more cost-effective than universal vaccination in Ireland. This approach could save costs while maintaining significant protection against tuberculosis (TB).
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- The current Irish infant vaccination program utilizes universal BCG vaccination.
- The cost-effectiveness of this universal strategy is compared against a selective approach targeting high-risk infants.
Purpose of the Study:
- To compare the cost-effectiveness of universal infant BCG vaccination versus selective vaccination of high-risk infants in Ireland.
- To inform policy decisions regarding infant BCG vaccination strategies.
Main Methods:
- Decision analytical modeling was employed to assess cost-effectiveness over a 15-year time horizon.
- The model evaluated a birth cohort, comparing vaccinated and unvaccinated infants.
- Life years gained (LYG) was the primary outcome measure, alongside net vaccination costs.
Main Results:
- The universal strategy yielded an incremental cost-effectiveness ratio (ICER) of €204,373/LYG, while the selective strategy showed an ICER of €143,233/LYG.
- Shifting to a selective strategy resulted in cost savings of €1,055,692 per birth cohort, with a minimal loss of 4.8 life years.
- Probabilistic analysis indicated a 76.8% probability that a selective strategy is cost-effective.
Conclusions:
- The BCG vaccine demonstrates a protective effect in infants.
- A selective infant BCG vaccination strategy appears more cost-effective than the current universal program.
- Resources could be reallocated from universal vaccination to enhance tuberculosis (TB) case management and control.
Background:
The aim of this study was to compare the cost effectiveness of the current Irish programme of universal BCG vaccination of infants versus a programme which considered selectively vaccinating high risk infants using decision analytical modelling.
Methods:
The efficacy of the BCG vaccine was re-evaluated to inform a decision analytical model constructed to follow a birth cohort of vaccinated and unvaccinated infants over a 15 year time horizon. The number of life years gained (LYG) was the primary outcome measure and this was compared to the net cost of the vaccination strategies.
Results:
In the base case analysis, the incremental cost effectiveness ratios (ICERs) for the universal strategy and selective strategy vs no vaccination were €204,373/LYG and €143,233/LYG respectively. When comparing the incremental difference in moving from the universal to the selective strategy, the selective strategy costs €1,055,692 less per 4.8 life years lost per birth cohort. One way sensitivity analyses highlighted that a move from the universal to the selective strategy was particularly sensitive to the estimate of vaccine efficacy against deaths, the cost of administering the vaccine and the multiplier used to apportion risk of contracting tuberculosis. Probabilistic analysis suggested that a move from a universal based strategy to a selective based strategy could be deemed cost effective (probability of cost effectiveness is 76.8 %).
Conclusion:
The results of the study support the protective effect of the BCG vaccine in infants and quantified the cost effectiveness of the current BCG vaccination strategy and the decremental difference in moving to a selective strategy. This analysis highlights that the additional protection offered by the universal vaccination strategy is small compared to that of the selective strategy. Consideration should therefore be given to the implementation of a selective vaccination strategy, and diverting resources to improve TB case management and control.
