Abstract
BackgroundIncreasing the number of vaccine doses may potentially improve overall efficacy. Decision-makers need information about choosing the most efficient dose schedule to maximise the total health gain of a population when operating under a constrained budget. The objective of this study is to identify the most efficient vaccine dosing schedule within a fixed vaccination budget from a healthcare payer perspective.MethodsAn optimisation model is developed in which maximizing the disease reduction is the functional objective and the constraint is the vaccination budget. The model allows variation in vaccination dosing numbers, in cost difference per dose, in vaccine coverage rate, and in vaccine efficacy. We apply the model using the monovalent rotavirus vaccine as an example.ResultsWith a fixed budget, a 2-dose schedule for vaccination against rotavirus infection with the monovalent vaccine results in a larger reduction in disease episodes than a 3-dose scheme with the same vaccine under most circumstances. A 3-dose schedule would only be better under certain conditions: a cost reduction of >26% per dose, combined with vaccine efficacy improvement of ≥5% and a target coverage rate of 75%. Substantial interaction is observed between cost reduction per dose, vaccine coverage rate, and increased vaccine efficacy. Sensitivity analysis shows that the conditions required for a 3-dose strategy to be better than a 2-dose strategy may seldom occur when the budget is fixed. The model does not consider vaccine herd effect, precise timing for additional doses, or the effect of natural immunity development.ConclusionsUnder budget constraint, optimisation modelling is a helpful tool for a decision-maker selecting the most efficient vaccination dosing schedule. The low dosing scheme could be the optimal option to consider under the many scenarios tested. The model can be applied under many different circumstances of changing dosing schemes with single or multiple vaccines.
Highlights
Increasing the number of vaccine doses may potentially improve overall efficacy
Rotavirus infection results in a high burden of acute gastroenteritis disease in children, especially in lowincome countries, with approximately 450,000 deaths that could be prevented each year by vaccination [2]
The health benefit gained by vaccination with a 2-dose schedule would be a reduction of Parameter Total vaccination budget Cost/dose for 2-dose vaccine schedule Cost/dose for 3-dose vaccine schedule Diarrhoea incidence rate per child per year Vaccine efficacy for 2-dose vaccine schedule Vaccine efficacy for 3-dose vaccine schedule Number of vaccine doses for strategy A Number of vaccine doses for strategy B Population Target vaccine coverage rate Average treatment cost per diarrhoea event
Summary
Increasing the number of vaccine doses may potentially improve overall efficacy. Decision-makers need information about choosing the most efficient dose schedule to maximise the total health gain of a population when operating under a constrained budget. The objective of this study is to identify the most efficient vaccine dosing schedule within a fixed vaccination budget from a healthcare payer perspective. The initial dosing schedule of a new vaccine is based on the results obtained in randomised clinical trials which evaluate the efficacy at the individual level. When realworld data on effectiveness become available questions may be raised over whether the initial dosing schedule is the most appropriate one to achieve the maximum benefit at the population level from limited available healthcare. Trials and observational studies conducted in low-income countries have reported lower vaccine efficacy than in high-income countries [7,8,9]. The morbidity and mortality impact expected in low-income countries greatly surpasses that in high-income countries, despite the lower inferred vaccine efficacy [12]
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