The Economic Costs of Malaria in Children in three Sub-Saharan Countries: Ghana, Tanzania and Kenya.

Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Household and health system costs per malaria episode ranged from approximately US$5 for non-complicated malaria in Tanzania to US$288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0--1 and 1--4 years were US$11.8 and US$13.8 in Ghana, US$6.9 and US$8.1 in Tanzania, and US$7.6 and US$8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$1.29 for children aged 2--11 months in Tanzania to a maximum of US$22.9 for children aged 0--24 months in Kenya. The total annual costs (in millions) were estimated at US$37.8, US$131.9 and US$109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$11.99, US$6.79 and US$20.54, respectively. This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions

Economic Impact of a Rotavirus Vaccine in Brazil

The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio

Geospatial Planning and the Resulting Economic Impact of Human Papillomavirus Vaccine Introduction in Mozambique

Research has shown that the distance to the nearest immunization location can ultimately prevent someone from getting immunized. With the introduction of human papillomavirus (HPV) vaccine throughout the world, a major question is whether the target populations can readily access immunization

Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study

Introduction: Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups. Methods: We build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016–2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment. Results: In the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion. Conclusion: Our findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City

Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$(2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50reported to have meningitis (3/6); 33meningococcaemia and myocarditis (2/6); 50bacteraemia (3/6); 66Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak

The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries.

With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention

Evaluating the costs of pneumococcal disease in selected Latin American countries Evaluación de los costos de la enfermedad neumocócica en países seleccionados de América Latina

OBJECTIVES: To estimate the costs of pneumococcal disease in Brazil, Chile and Uruguay, to describe how these costs vary between different patient groups, and to discuss factors that affect these cost variations. METHODS: The cost of pneumococcal disease was estimated from the health care perspective. For each country, baseline cost estimates were primarily developed using health resources information from patient-level data and facility-specific cost data. A regression model was constructed separately for four types of pneumococcal diseases. The skewness-kurtosis test and the Cook-Weisberg test were performed to test the normality of the residuals and the heteroscedasticity, respectively. RESULTS: The treatment of pneumococcal meningitis generated up to US$5 435 per child. The treatment costs of pneumococcal pneumonia were lower, ranging from US$ 372 per child to US$3 483 per child. Treatment of acute otitis media cost between US$ 20 per child and US$217 per child. The main source of treatment costs variations was level of service provided and country in which costs were incurred. However, the tendency of costs to change with these variables was not statistically significant at the 5$ 5 435 por cada niño, mientras el de la neumonía neumocócica fue menor, entre US$372 y US$ 3 483 por niño. El costo del tratamiento de la otitis media aguda fue de US$20 a US$ 217 por niño. La principal fuente de variación en los costos de tratamiento fue el nivel de servicio brindado y el país en que se generaron los costos. No obstante, la tendencia de los costos a variar no fue estadísticamente significativa (P > 0,05) en la mayoría de los modelos de la enfermedad neumocócica. CONCLUSIONES: La enfermedad neumocócica constituye una notable carga económica para los sistemas de salud seleccionados de América Latina. Los patrones del costo de tratamiento de la enfermedad neumocócica mostraron una gran variación

Evaluating the cost-effectiveness of vaccine introduction and its potential policy implications in Latin America

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Economic impact of pneumococcal conjugate vaccination in Brazil, Chile, and Uruguay <?a_ID=3D1191>

Objetivos. Evaluar el impacto econ\uf3mico de la aplicaci\uf3n de la vacuna antineumoc\uf3cica conjugada heptavalente (PCV7) en Brasil, Chile y Uruguay. M\ue9todos. Se elabor\uf3 un modelo anal\uedtico de decisiones para comparar la vacunaci\uf3n antineumoc\uf3cica de los ni\uf1os de 0-5 a\uf1os de edad con la no vacunaci\uf3n, en Brasil, Chile y Uruguay. Los costos y los desenlaces para la salud se analizaron desde el punto de vista de la sociedad. Al an\ue1lisis econ\uf3mico se incorporaron los costos y los datos demogr\ue1ficos, epidemiol\uf3gicos y de la vacuna. Resultados. Con una cobertura como la de la vacuna contra la difteria, el t\ue9tanos y la tos ferina (DTP) y un precio de US 53,00 por dosis, la vacuna PCV7 podr\ueda evitar 23 474 muertes anuales en ni\uf1os menores de 5 a\uf1os en los tres pa\uedses estudiados, con lo que se evitar\uedan anualmente 884 841 a\uf1os de vida ajustados por discapacidad (AVAD). Para vacunar toda la cohorte de reci\ue9n nacidos de los tres pa\uedses, el costo total de la vacuna ser\ueda de US 613,9 millones. A US 53,00 por dosis, el costo por AVAD evitado desde la perspectiva de la sociedad variar\ueda entre US 664,00 (en Brasil) y US$2 019,00 (en Chile). A US$ 10,00 por dosis, el costo de la vacuna ser\ueda menor que el costo total de la enfermedad evitada (US$125 050 497 frente a US$ 153 965 333), lo que ser\ueda efectivo en funci\uf3n del costo y representar\ueda un ahorro. Conclusiones. Estos resultados demuestran que la incorporaci\uf3n de la vacuna PCV7 a US$ 53,00 por dosis ofrece beneficios con un costo adicional. No queda claro si estos pa\uedses pueden costear la vacunaci\uf3n a los precios actuales

Post-introduction economic evaluation of pneumococcal conjugate vaccination in Ecuador, Honduras, and Paraguay

OBJECTIVE:A decision-analytic model was constructed to evaluate the economic impact of post-introduction pneumococcal conjugate vaccine (PCV) programs in Ecuador, Honduras, and Paraguay from the societal perspective. METHODS: Hypothetical birth cohorts were followed for a 20-year period in each country. Estimates of disease burden, vaccine effectiveness, and health care costs were derived from primary and secondary data sources. Costs were expressed in 2014 US$. Sensitivity analyses were performed to assess the impact of model input uncertainties. RESULTS: Over the 20 years of vaccine program implementation, the health care costs per case ranged from US$ 764 854 to more than US$1 million. Vaccination prevented more than 50$ 16 per dose, the cost per disability-adjusted life year (DALY) averted for the 10-valent PCV (PCV10) and the 13-valet PCV (PCV13) ranged from US$796 (Honduras) to US$ 1 340 (Ecuador) and from US$691 (Honduras) to US$ 1 166 (Ecuador) respectively. At a reduced price (US$7 per dose), the cost per DALY averted ranged from US$ 327 (Honduras) to US$528 (Ecuador) and from US$ 281 (Honduras) to US$ 456 (Ecuador) for PCV10 and PCV13 respectively. Several model parameters influenced the results of the analysis, including vaccine price, vaccine efficacy, disease incidence, and costs. CONCLUSIONS: The economic impact of post-introduction PCV needs to be assessed in a context of uncertainty regarding changing antibiotic resistance, herd and serotype replacement effects, differential vaccine prices, and government budget constraints