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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.
Summary
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.
