Abstract
The potential occurrence of disease outbreaks during the hajj season is of great concern due to extreme congestion in a confined space. This promotes the acquisition, spread and transmission of pathogenic microorganisms and pneumococcal disease are one of the most frequent infections among Hajj pilgrims. This study aimed to assess the cost-effectiveness and budget impact of introducing the PPV23 to Malaysian Hajj pilgrims. A decision tree framework with a 1-year cycle length was adapted to evaluate the cost-effectiveness of a PPV23 vaccination program with no vaccination. The cost information was retrieved from the Lembaga Tabung Haji Malaysia (LTH) database. Vaccine effectiveness was based on the locally published data and the disease incidence specifically related to Streptococcus pneumoniae was based on a literature search. Analyses were conducted from the perspective of the provider: Ministry of Health and LTH Malaysia. The incremental cost-effectiveness ratios (ICER), cases averted, and net cost savings were estimated. Findings from this study showed that PPV23 vaccination for Malaysian Hajj pilgrims was cost-effective. The PPV23 vaccination programme has an ICER of MYR -449.3 (US$-110.95) per case averted. Based on the national threshold value of US$6,200-US$8,900 per capita, the base-case result shows that introduction of the PPV23 vaccine for Malaysian Hajj pilgrims is very cost-effective. Sensitivity analysis revealed parameters related to annual incidence and hospitalised cost of septicemia and disease without vaccination as the key drivers of the model outputs. Compared with no vaccination, the inclusion of PPV23 vaccination for Malaysian Hajj pilgrims was projected to result in a net cost saving of MYR59.6 million and 109,996 cases averted over 5 years period. The PPV23 vaccination program could substantially offer additional benefits in reducing the pneumococcal disease burden and healthcare cost. This could be of help for policymakers to consider the implementation of PPV23 vaccination for Malaysian performing hajj.
Highlights
Millions of Muslims from more than 180 countries converge in Saudi Arabia to perform Hajj each year [1]
It was estimated that vaccination with a PPV23 would prevent 35,937 pneumococcal-related cases compared with no vaccination strategy for the Malaysian Hajj pilgrims of 40,837 in 2017
The PPV23 vaccination would incur a cost of MYR8.8 million while the Malaysian health system would incur a total cost of MYR18 million for the study cohort due to pneumococcal disease without vaccination in place
Summary
Millions of Muslims from more than 180 countries converge in Saudi Arabia to perform Hajj each year [1]. The overcrowding and extreme congestion due to confined spaces present a significant challenge to the health of Hajj pilgrims as they are more susceptible to acquiring and spreading infectious diseases, likes respiratory tract infections. Community-acquired pneumonia (CAP) is the primary cause of critical illness and the leading cause of hospital admission among Hajj pilgrims [2,3,4]. A broad array of pathogens are corresponding to respiratory disorders, with Streptococcus pneumoniae being the most common isolated from patients [5]. This pathogen could cause diseases with varied in severity from otitis media to CAP, through invasive pneumococcal diseases (IPD) such as meningitis and septicemia. Individuals with chronic diseases, the elderly and infants are at risk of severe infection [6, 7]
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