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Cost minimization analysis of a hexavalent vaccine in Argentina
Ignacio Olivera1, Carlos Grau Pérez1, Luis Lazarov1
1Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay.
Insights
Switching to a hexavalent vaccine in Argentina offers marginal cost increases, largely offset by reduced adverse events and improved logistics. This analysis compares the DTwP-Hib-HB plus IPV schedule with the DTaP-Hib-HB-IPV alternative.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Argentina currently uses a pentavalent vaccine (DTwP-Hib-HB) plus inactivated polio vaccine (IPV).
- Hexavalent vaccines (DTaP-Hib-HB-IPV) are available privately or for high-risk preterm infants.
- Effectiveness of both schedules is assumed to be similar.
Purpose of the Study:
- To analyze the cost-effectiveness of switching from the current pentavalent vaccine plus IPV schedule to a hexavalent vaccine schedule in Argentina.
- To evaluate societal, public sector, and specific infant subgroup costs associated with the vaccine schedule change.
Main Methods:
- Societal cost analysis of infants (≤1 year) born in Argentina (2015-2019).
- Consideration of adverse events, programmatic, logistic, and vaccine costs for both schedules.
- Disaggregation of costs for the public sector and vaccination of preterm infants.
Main Results:
- The alternative hexavalent vaccine schedule incurs an additional US$39.8 million in vaccine costs.
- Overall societal costs increase by only US$3.6 million due to savings in adverse events and programmatic costs.
- Additional public sector costs are US$2.1 million, with US$84,023 for preterm infant vaccination.
Conclusions:
- Switching to the hexavalent vaccine (DTaP-Hib-HB-IPV) in Argentina results in slightly higher direct vaccine expenses.
- These increased costs are substantially offset by reduced adverse event-related expenses and improved logistical efficiencies.
- The overall economic impact favors the hexavalent vaccine schedule when considering a broader societal perspective.
Background:
Argentina currently uses a pentavalent vaccine containing diphtheria, tetanus, pertussis (whole cell), Haemophilus influenza type b and hepatitis B antigens, administered concomitantly with the inactivated polio vaccine (IPV) (DTwP-Hib-HB plus IPV) in its childhood vaccination schedule. However, hexavalent vaccines containing acellular pertussis antigens (DTaP-Hib-HB-IPV) and providing protection against the same diseases are also licensed, but are only available with a private prescription or for high-risk pre-term infants in the public health program. We analyzed the cost of switching from the current schedule to the alternative schedule with the hexavalent vaccine in Argentina, assuming similar levels of effectiveness.
Methods:
The study population was infants ≤ 1 year of age born in Argentina from 2015 to 2019. The analysis considered adverse events, programmatic, logistic, and vaccine costs of both schemes from the societal perspective. The societal costs were disaggregated to summarize costs incurred in the public sector and with vaccination pre-term infants in the public sector. Costs were expressed in 2021 US Dollars (US$).
Results:
Although the cost of vaccines with the alternative scheme would be US$39.8 million (M) more than with the current scheme, these additional costs are in large part offset by fewer adverse event-associated costs and lower programmatic costs such that the overall cost of the alternative scheme would only be an additional US$3.6 M from the societal perspective. The additional cost associated with switching to the alternative scheme in the public sector and with the vaccination of pre-term infants in the public sector would be US$2.1 M and US$84,023, respectively.
Conclusions:
The switch to an alternative scheme with the hexavalent vaccine in Argentina would result in marginally higher vaccine costs, which are mostly offset by the lower costs associated with improved logistics, fewer separate vaccines, and a reduction in adverse events.
