Thirty years of vaccination in Vietnam: Impact and cost-effectiveness of the national Expanded Programme on Immunization

Mark Jit,Dang Thi Thanh Huyen,Ingrid Friberg,Hoang Van Minh,Pham Huy Tuan Kiet,Neff Walker,Nguyen Van Cuong,Tran Nhu Duong,Kohei Toda,Raymond Hutubessy,Kimberley Fox,Nguyen Tran Hien

doi:10.1016/j.vaccine.2014.12.017

Abstract

IntroductionCountries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines. However, the impact and cost-effectiveness of the Expanded Programme on Immunization (EPI) as a whole has never been assessed on a country level. MethodsData on vaccine-preventable disease incidence and mortality from Vietnam's national surveillance was analysed to estimate the likely impact that vaccination in 1980–2010 may have had. Adjustment for under-reporting was made by examining trends in reported mumps incidence and in case-fatality risks for each disease. The same data were separately analysed using the Lives Saved Tool (LiST) to give an alternative estimate of impact. The financial cost of EPI in 1996–2010 was also estimated from the perspective of service provider. ResultsNational surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI. Analysis using LiST suggests that even more deaths (370,000) may have been prevented by measles and pertussis vaccination alone. The cost-effectiveness of EPI is estimated to be around $1000–$27,000 per death prevented. ConclusionTwo separate approaches to assessing EPI impact in Vietnam give different quantitative results but a common conclusion: that EPI has made a substantial impact on mortality and represents good value for money.

Highlights

Countries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines
Between 1980 and 2011, global coverage of the third dose of diphtheria–pertussis–tetanus vaccine (DPT) increased from 20% to 83%, while that of measles-containing vaccine increased from 16% to 85% [1]
Models predict a spike in diphtheria and pertussis incidence around 2002 which did not occur in practice, despite a sharp decline in DPT coverage from 96% in 2001 to 75% in 2002

Summary

Introduction

Countries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines. Methods: Data on vaccine-preventable disease incidence and mortality from Vietnam’s national surveillance was analysed to estimate the likely impact that vaccination in 1980–2010 may have had. The same data were separately analysed using the Lives Saved Tool (LiST) to give an alternative estimate of impact. Results: National surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI. The Expanded Programme on Immunization (EPI) was established by the World Health Organization (WHO) in 1974 to support countries in increasing uptake of vaccines against measles, Abbreviations: DALY, disability adjusted life year; DPT, diphtheria–pertussis– tetanus vaccine; EPI, Expanded Programme on Immunization; LiST, Lives Saved Tool. Passive surveillance of trends in disease incidence may be affected by underreporting, of cases that do not present for health care. Even if declines in severe disease and mortality are well-documented, these may be due to improved access to care, nutrition and general health as well as vaccination

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