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Vaccine
03 20, 2018;36 (13): 1757-1765.

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option.

Kinley Dorji, Sonam Phuntsho, Suthasinee Kumluang, Sarayuth Khuntha, Wantanee Kulpeng, Sneha Rajbhandari, Yot Teerawattananon
Author Information
  1. Kinley Dorji: Essential Medicine & Technology Division, Ministry of Health, PO Box 726, Thimphu, Bhutan. Electronic address: dorjik@health.gov.bt.
  2. Sonam Phuntsho: Policy & Planning Division, Ministry of Health, PO Box 726, Thimphu, Bhutan. Electronic address: sphuntsho@health.gov.bt.
  3. Pempa: Essential Medicine & Technology Division, Ministry of Health, PO Box 726, Thimphu, Bhutan. Electronic address: pemba@health.gov.bt.
  4. Suthasinee Kumluang: Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand. Electronic address: suthasinee.k@hitap.net.
  5. Sarayuth Khuntha: Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand. Electronic address: sarayuth.k@hitap.net.
  6. Wantanee Kulpeng: Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand. Electronic address: wantanee.k@hitap.net.
  7. Sneha Rajbhandari: Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand. Electronic address: sneha_r@hitap.net.
  8. Yot Teerawattananon: Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand. Electronic address: yot.t@hitap.net.
PMID: 29478752 DOI: 10.1016/j.vaccine.2018.02.048

Abstract

BACKGROUND: Due to competing health priorities and limited resources, many low-income countries, even those with a high disease burden, are not able to introduce pneumococcal conjugate vaccines.
OBJECTIVE: To determine the cost-utility of 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan.
METHODS: A model-based cost-utility analysis was performed in the Bhutanese context using a government perspective. A Markov simulation model with one-year cycle length was used to estimate the costs and outcomes of three options: PCV10, PCV13 and no PCV programmes for a lifetime horizon. A discount rate of 3% per annum was applied. Results are presented using an incremental cost-effectiveness ratio (ICER) in United State Dollar per quality-adjusted life year (QALY) gained (USD 1 = Ngultrum 65). A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty.
RESULTS: Compared to no vaccination, PCV10 and PCV13 gained 0.0006 and 0.0007 QALYs with additional lifetime costs of USD 0.02 and USD 0.03 per person, respectively. PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained compared to no vaccination. In addition, PCV13 produced an ICER of USD 92 compared with PCV10. When including PCV into the Expanded Programme on Immunization, the total 5-year budgetary requirement is anticipated to increase to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6-1.1 FTE) and nurse (1-1.6 FTE).
CONCLUSION: At the suggested threshold of 1xGDP per capita equivalent to USD 2708, both PCVs are cost-effective in Bhutan and we recommend that they be included in the routine immunization programme.

Keywords

Bhutan Cost-utility analysis Human resources for health PCV Pneumococcal conjugate vaccines

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MeSH Term

Adolescent
Adult
Aged
Aged, 80 and over
Bhutan
Child
Child, Preschool
Cost-Benefit Analysis
Health Care Costs
Health Policy
Humans
Immunization Programs
Incidence
Infant
Markov Chains
Middle Aged
Outcome Assessment, Health Care
Pneumococcal Infections
Pneumococcal Vaccines
Streptococcus pneumoniae
Vaccination
Vaccines, Conjugate
Young Adult

Chemicals

10-valent pneumococcal conjugate vaccine
13-valent pneumococcal vaccine
Pneumococcal Vaccines
Vaccines, Conjugate
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 3

Word Cloud

Created with Highcharts 10.0.0USDPCV10PCV13per0analysishealthconjugatevaccinesFTEpneumococcalcost-utilitycomparedvaccinationBhutanPCVyeargainedresourcesdetermineusingcostslifetimeICERQALYsensitivityincrease3millionequivalentBACKGROUND:Duecompetingprioritieslimitedmanylow-incomecountriesevenhighdiseaseburdenableintroduceOBJECTIVE:10-13-valentMETHODS:model-basedperformedBhutanesecontextgovernmentperspectiveMarkovsimulationmodelone-yearcyclelengthusedestimateoutcomesthreeoptions:programmeshorizondiscountrate3%annumappliedResultspresentedincrementalcost-effectivenessratioUnitedStateDollarquality-adjustedlife1 = Ngultrum65one-wayprobabilisticconductedassessuncertaintyRESULTS:Compared00060007QALYsadditional0203personrespectivelygeneratedICERs3640additionproduced92includingExpandedProgrammeImmunizationtotal5-yearbudgetaryrequirementanticipated7775Moreoverfull-timeoneassistant2workerscanreducedparticularlyspecialist6-11nurse1-16CONCLUSION:suggestedthreshold1xGDPcapita2708PCVscost-effectiverecommendincludedroutineimmunizationprogrammeTowardsintroductionBhutan:optimalpolicyoptionCost-utilityHumanPneumococcal

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