Abstract
Current study aimed to estimate clinical and economic outcomes of providing the Haemophilus influenzae type b (Hib) vaccination as a national vaccine immunization program in Thailand. A decision tree combined with Markov model was developed to simulate relevant costs and health outcomes covering lifetime horizon in societal and health care payer perspectives. This analysis considered children aged under 5 years old whom preventive vaccine of Hib infection are indicated. Two combined Hib vaccination schedules were considered: three-dose series (3 + 0) and three-dose series plus a booster does (3 + 1) compared with no vaccination. Budget impact analysis was also performed under Thai government perspective. The outcomes were reported as Hib-infected cases averted and incremental cost-effectiveness ratios (ICERs) in 2014 Thai baht (THB) ($) per quality-adjusted life year (QALY) gained. In base-case scenario, the model estimates that 3,960 infected cases, 59 disability cases, and 97 deaths can be prevented by national Hib vaccination program. The ICER for 3 + 0 schedule was THB 1,099 ($34) per QALY gained under societal perspective. The model was sensitive to pneumonia incidence among aged under 5 years old and direct non-medical care cost per episode of Hib pneumonia. Hib vaccination is very cost-effective in the Thai context. The budget impact analysis showed that Thai government needed to invest an additional budget of 110 ($3.4) million to implement Hib vaccination program. Policy makers should consider our findings for adopting this vaccine into national immunization program.
Highlights
Haemophilus influenzae type b (Hib) is a leading cause of childhood bacterial meningitis, pneumonia, and other serious infections, associated with substantial morbidity and mortality among children under 5 years of age [1]
There was only one economic evaluation of universal Hib vaccination based on cost-benefit analysis (CBA) for Thailand conducted in year 2010 [14]
Our model estimates that vaccinating children with Hib vaccine would save nearly Thai baht (THB) 118.24 ($3.6) in direct medical care costs and THB 32.20 ($1) in direct non-medical care costs per vaccinated child
Summary
Haemophilus influenzae type b (Hib) is a leading cause of childhood bacterial meningitis, pneumonia, and other serious infections, associated with substantial morbidity and mortality among children under 5 years of age [1]. Thailand and China are the only two countries in the whole world that has not introduced Hib vaccine as part of EPI [10] This is due to uncertainties around low Hib disease burden and high vaccine price, it has been available in Thailand since 2001 [11, 12]. There was only one economic evaluation of universal Hib vaccination based on cost-benefit analysis (CBA) for Thailand conducted in year 2010 [14]. It showed that the Hib vaccine was only cost-effective if intangible benefits were included in the model. The other factors contributing to unfavorable outcomes were vaccine unit price and Hib disease incidence
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