Abstract
BackgroundThe phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio ‘end-game’ strategy.MethodsWe analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26).ResultsThe overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme.ConclusionsThe switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
Highlights
The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio ‘end-game’ strategy
Because the new scheme represents a replacement of antigens, for both OPV to IPV and whole-cell pertussis component (wP) to acellular pertussis component (aP), without any significant difference in the efficacy of the switched antigens, we considered a costminimization analysis as the most appropriate economic evaluation methodology to utilize
The vaccination scheme in 2016, which consists of 4 doses of wP-containing pentavalent vaccine (DTwP-Haemophilus influenzae type b (Hib)-hepatitis B (HepB)) plus 1 dose IPV and 3 doses OPV, was based on the program from the Ministry of Health [23, 28] and the new scheme was assumed to replicate the same vaccine antigen coverage including the use of a ‘booster’ dose at 18 months
Summary
The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio ‘end-game’ strategy. Vaccines and associated pediatric immunization programs have been a vital public health intervention in reducing morbidity and mortality associated with many communicable diseases worldwide. These interventions protect those immunized, and provide community-wide protection by reducing the spread of Olivera et al BMC Health Services Research (2020) 20:295 aged < 5 years, representing $231 billion in the value of statistical lives saved [3]. The use of the formalin-inactivated Salk polio vaccine (IPV) (first introduced in 1955) and the Sabin oral polio vaccine (OPV) (introduced in the early 1960’s) in routine immunization programs and supplemental mass vaccination campaigns has led to the elimination or near elimination of poliomyelitis and polioviruses circulation from many countries [6]. First the switch from trivalent OPV to bivalent OPV (as wild type OPV-2 no longer circulates), and second the switch from OPV to IPV in routine childhood immunization programs in order to avoid OPV-derived cases [10,11,12]
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