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Potential health and economic impact of paediatric vaccination using next-generation influenza vaccines in Kenya: a
Naomi R Waterlow1, Sreejith Radhakrishnan2,3, Jeanette Dawa4,5
1Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK. lsh1402815@lshtm.ac.uk.
Insights
Next-generation influenza vaccines show promise for cost-effective use in Kenya, especially universal vaccines offering broad and long-term immunity. These improved vaccines could significantly reduce the burden of respiratory illness in children under 5.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Influenza poses a significant year-round respiratory health threat in Kenya, particularly impacting children under five.
- Current influenza vaccines offer limited, strain-specific immunity and have not proven cost-effective in Kenya.
- Next-generation influenza vaccines are under development with potential for improved impact and cost-effectiveness.
Purpose of the Study:
- To evaluate the cost-effectiveness of next-generation influenza vaccines in Kenya.
- To model the impact of vaccines with enhanced characteristics like increased effectiveness, broader cross-protection, and longer duration of immunity.
- To determine threshold prices for cost-effective vaccine introduction.
Main Methods:
- An existing cost-effectiveness model for seasonal influenza vaccines in Kenya was expanded.
- The model incorporated next-generation vaccines with variable effectiveness, breadth, and duration of immunity.
- Evaluations included incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), and willingness-to-pay (WTP) thresholds.
Main Results:
- Next-generation vaccines can be cost-effective, contingent on vaccine attributes and WTP.
- Universal vaccines, providing long-term and broad immunity, demonstrated the highest cost-effectiveness across multiple WTP thresholds.
- At a WTP of $623, universal vaccines are cost-effective up to a median price of $5.16 per dose.
Conclusions:
- Next-generation influenza vaccines present a potentially cost-effective intervention for reducing influenza burden in Kenya.
- Findings provide crucial evidence for policymakers and funders regarding the introduction and market potential of advanced influenza vaccines.
- The study highlights the significant impact of assumed immunity mechanisms on vaccine cost-effectiveness outcomes.
Background:
Influenza is a major year-round cause of respiratory illness in Kenya, particularly in children under 5. Current influenza vaccines result in short-term, strain-specific immunity and were found in a previous study not to be cost-effective in Kenya. However, next-generation vaccines are in development that may have a greater impact and cost-effectiveness profile.
Methods:
We expanded a model previously used to evaluate the cost-effectiveness of seasonal influenza vaccines in Kenya to include next-generation vaccines by allowing for enhanced vaccine characteristics and multi-annual immunity. We specifically examined vaccinating children under 5 years of age with improved vaccines, evaluating vaccines with combinations of increased vaccine effectiveness, cross-protection between strains (breadth) and duration of immunity. We evaluated cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs) for a range of values for the willingness-to-pay (WTP) per DALY averted. Finally, we estimated threshold per-dose vaccine prices at which vaccination becomes cost-effective.
Results:
Next-generation vaccines can be cost-effective, dependent on the vaccine characteristics and assumed WTP thresholds. Universal vaccines (assumed to provide long-term and broad immunity) are most cost-effective in Kenya across three of four WTP thresholds evaluated, with the lowest median value of ICER per DALY averted ($263, 95% Credible Interval (CrI): $ - 1698, $1061) and the highest median INMBs. At a WTP of $623, universal vaccines are cost-effective at or below a median price of $5.16 per dose (95% CrI: $0.94, $18.57). We also show that the assumed mechanism underlying infection-derived immunity strongly impacts vaccine outcomes.
Conclusions:
This evaluation provides evidence for country-level decision makers about future next-generation vaccine introduction, as well as global research funders about the potential market for these vaccines. Next-generation vaccines may offer a cost-effective intervention to reduce influenza burden in low-income countries with year-round seasonality like Kenya.
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