Abstract
Influenza outbreaks in Thai prisons were increasing in number every year and to address this, the Thai Ministry of Public Health (MOPH) initiated a policy to promote vaccination for prisoners. The objective of this study was to assess the cost effectiveness and budget impact of the influenza vaccination policy for prisoners in Thailand. The study obtained data from the Division of Epidemiology, Department of Disease Control (DDC), MOPH. Deterministic system dynamic modelling was exercised to estimate the financial implication of the vaccination programme in comparison with routine outbreak control. The incremental cost-effectiveness ratio (ICER) was calculated via a DDC perspective. The reproductive number was estimated at 1.4. A total of 143 prisons across the country (375,763 prisoners) were analysed. In non-vaccination circumstances, the total healthcare cost amounted to 174.8 million Baht (US$ 5.6 million). Should all prisoners be vaccinated, the total healthcare cost would reduce to 90.9 million Baht (US$ 2.9 million), and 46.8 million Baht (US$ 1.5 million) of this is related to the vaccination. The ICER of vaccination (compared with routine outbreak control) varied between 39,738.0 to 61,688.3 Baht per disability-adjusted life year (DALY) averted (US$ 1281.9–1989.9). Should the vaccination cover 30% of the prisoners, the ICER would be equal to 46,866.8 Baht (US$ 1511.8) per DALY averted with the budget burden amounted to Baht (US$ 4.8 million). The vaccination programme would become more cost-effective if the routine outbreak control was intensified. In summary, the vaccination programme was a cost-effective measure to halt influenza outbreak amongst prisoners. Further primary studies that aim to assess the actual impact of the programme are recommended.
Highlights
Seasonal Influenza has been long recognized as a vital cause of morbidity and mortality in humans for years [1]
To the authors’ knowledge, this study is likely to be the first study in Thailand, and possibly in Southeast Asia, that has performed a comprehensive analysis on a vaccination policy for prisoners, in terms of both health outcomes and budget impact
These points lead to a couple of recommendations: (i) further studies that account for uncertainty of parameters are needed, and (ii) if the vaccination policy is implemented, a monitoring system should be established in parallel
Summary
Seasonal Influenza has been long recognized as a vital cause of morbidity and mortality in humans for years [1]. In 2017 the World Health Organization (WHO) estimated that seasonal influenza was associated with all-cause mortality in about 250,000–500,000 deaths annually [2]. Those who are at great risk of serious complications and mortality are mostly vulnerable populations, including people with immuno-compromised host, young children, and the elderly [3,4]. Res. Public Health 2020, 17, 1247; doi:10.3390/ijerph17041247 www.mdpi.com/journal/ijerph
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