Abstract
BackgroundTyphoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. Methods and findingsWe evaluated routine infant vaccination with and without catch-up campaigns among older individuals. We used a dynamic model of typhoid transmission to simulate cases, hospitalizations, deaths, disability-adjusted life-years (DALY) lost, treatment and intervention costs. We estimated cost-effectiveness (in terms of cost in international dollars (I$) per DALY averted) from the healthcare payer perspective, and assessed how it was influenced by uncertain model parameters. Compared to no vaccination, routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, “very cost-effective” in Kolkata and Nairobi, and “cost-effective” in Lwak according to World Health Organization thresholds. However, routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being cost-saving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak. Vaccine price impacted the optimal strategy, and the number of doses required and rate of hospitalization were the primary sources of uncertainty. ConclusionRoutine vaccination with TCV would be cost-effective in most settings, and additional one-time catch-up campaigns would also be economically justified.
Highlights
Between 11.9–26.9 million cases of typhoid fever occur each year in low- and middle-income countries (LMICs) [1,2,48,49]
Because vaccine prices have yet to be negotiated by the appropriate stakeholders, we assumed a price of 1 international dollar (I$) per dose in a single-dose schedule; we examined alternative pricing and dosing schedules in scenario analyses
The hospitalization rate had a notable impact on the disability-adjusted life-years (DALYs) lost over 10 years (Table 2)
Summary
Between 11.9–26.9 million cases of typhoid fever occur each year in low- and middle-income countries (LMICs) [1,2,48,49]. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. Routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, ‘‘very cost-effective” in Kolkata and Nairobi, and ‘‘cost-effective” in Lwak according to World Health Organization thresholds. Routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being costsaving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak.
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