Abstract
Some African countries are still reluctant to introduce the hepatitis B vaccine birth dose (HepB-BD) into their expanded program of immunization (EPI), partly because of logistical, economic, and cost information constraints. To assist decision-makers in these countries, we assessed the economic and financial costs of HepB-BD introduction in Senegal in 2016. We performed a micro-costing study in a representative sample of Senegal’s EPI sites at all levels in 2018. Information on EPI and HepB-BD activity-related inputs and costs was collected using standardized questionnaires and semi-structured interviews. Using inverse probability weighting, we computed weighted average costs associated with HepB-BD introduction for each EPI level, country-level aggregated costs and estimated costs per newborn. Economic and financial costs from a government perspective were estimated in US dollars for 2015, 2016 and 2017. Total economic costs were USD 143,364 in 2015, USD 759,406 in 2016 and USD 867,311 in 2017, while financial costs were USD 127,745, USD 82,519 and USD 29,853, respectively. When annualizing pre-introduction and initial training costs, the economic (financial) cost per vaccinated newborn was USD 2.10 (USD 0.30) in 2016 and USD 1.90 (USD 0.20) in 2017. Our estimates provide valuable information to implement HepB-BD in Sub-Saharan African countries that have not yet integrated this vaccine.
Highlights
To reduce the hepatitis B virus (HBV) burden in Sub-Saharan Africa, priority must be given to preventing the infection in newborns and young children for the following reasons: (i) HBV transmission mainly occurs during early childhood through perinatal and horizontal transmission, (ii) the risk of developing chronic HBV infection is very high when infection occurs during the first year of life (90%) and rapidly decreases with age to
Using data from a micro-costing study designed to obtain a representative sample of sites involved in implementing the country’s expanded program of immunization (EPI), we identified and valued the resources mobilized for a large range of activities related to the introduction and implementation of the hepatitis B vaccine birth dose (HepB-BD) at the different levels of Senegal’s health system
Our costs analyses based on the Senegal context provide important insights for other African countries regarding the types and amount of resources and costs required to introduce HepB-BD
Summary
All African countries have introduced the three-dose infant HBV vaccine (HepB3) into their current expanded program of immunization (EPI) as part of a pentavalent vaccine, HBV prevalence is still high in the region (at least 8% in adults and 3% in children under 5 years old) [1,2]. To reduce the HBV burden in Sub-Saharan Africa, priority must be given to preventing the infection in newborns and young children for the following reasons: (i) HBV transmission mainly occurs during early childhood through perinatal and horizontal transmission,. To effectively prevent perinatal and early horizontal transmission, the current HBV vaccination schedule recommended by the World Health Organization (WHO) is to administer the first dose within h of birth (hepatitis B birth dose vaccine (HepB-BD)), followed by two or three doses during infancy (HepB3) [7]. In 2014, an HepB-BD introduction plan was developed and discussed at a workshop, Agency for International Development.
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