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Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for
Janice Seinfeld1,2, Alfredo Sobrevilla3, María Laura Rosales3
1Videnza Consultores, Lima, Peru. jseinfeld@videnza.org.
Insights
Peru
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Infant vaccination coverage in Peru has declined, worsened by the COVID-19 pandemic.
- The introduction of a hexavalent vaccine (diphtheria, tetanus, acellular pertussis, inactivated polio, hepatitis B, Haemophilus influenzae type B) is proposed to improve coverage.
- This study evaluates the costs and outcomes of switching from a pentavalent vaccine plus polio vaccine to the hexavalent vaccine.
Purpose of the Study:
- To assess the economic and healthcare impact of introducing a hexavalent vaccine into Peru's National Immunization Program.
- To compare the costs and coverage rates of the current pentavalent vaccine scheme with a new hexavalent vaccine scheme.
- To analyze the impact on vaccine-preventable diseases and adverse reactions.
Main Methods:
- A 5-year cohort analysis of children born in Peru in 2020 (N=494,595).
- Four scenarios were modeled: current pentavalent scheme, hexavalent scheme, expanded pentavalent scheme, and expanded hexavalent scheme.
- Monte Carlo simulations and Markov models were used to estimate coverage, adverse reactions, and disease incidence, with cost analysis from a public health payer perspective.
Main Results:
- The hexavalent vaccine scheme is projected to increase coverage by 9.4-14.3% points and reduce pertussis cases by 5.7-8.7%.
- Adverse reaction rates are estimated to decrease by 32% with the hexavalent vaccine.
- While initial costs increase, the cost per protected child is reduced with the hexavalent vaccine, which also showed lower cost variability.
Conclusions:
- Implementing the hexavalent vaccine in Peru's National Immunization Program offers positive public health and economic consequences.
- The hexavalent vaccine is associated with improved coverage, reduced disease incidence, and fewer adverse reactions.
- Cost-effectiveness analysis indicates a favorable outcome for the hexavalent vaccine strategy.
Background:
Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru's infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months).
Methods:
The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses.
Results:
The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis.
Conclusions:
Implementation of the hexavalent vaccine in Peru's National Immunization Program has a positive public health cost consequence.
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