Cost-effectiveness analysis of Japanese Encephalitis (JE) vaccination program in Bali Province, Indonesia

Wayan Citra Wulan Sucipta Putri; Anak Agung Sagung Sawitri; Putu Cintya Denny Yuliyatni; I Made Dwi Ariawan; Hashta Meyta; Sofya Umi Labiba; I Gusti Ngurah Made Suwarba; I Nyoman Sutarsa

doi:10.1016/j.vaccine.2023.10.007

Cost-effectiveness analysis of Japanese Encephalitis (JE) vaccination program in Bali Province, Indonesia

Vaccine. 2023 Nov 13;41(47):6930-6940. doi: 10.1016/j.vaccine.2023.10.007. Epub 2023 Oct 21.

Authors

Wayan Citra Wulan Sucipta Putri¹, Anak Agung Sagung Sawitri², Putu Cintya Denny Yuliyatni², I Made Dwi Ariawan², Hashta Meyta³, Sofya Umi Labiba³, I Gusti Ngurah Made Suwarba⁴, I Nyoman Sutarsa⁵

Affiliations

¹ Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali 80232, Indonesia. Electronic address: suciptaputri@unud.ac.id.
² Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali 80232, Indonesia.
³ Directorate General Prevention and Control of Disease, Ministry of Health, Jakarta, Indonesia.
⁴ Department of Child Health, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali 80232, Indonesia.
⁵ Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali 80232, Indonesia; School of Medicine and Psychology, College of Health and Medicine, The Australian National University, ACT 2001, Australia.

PMID: 37866992
DOI: 10.1016/j.vaccine.2023.10.007

Abstract

Objective: The incidence of Japanese Encephalitis (JE) in Bali Province remains high, and is one among the highest in Indonesia. The Indonesian Government initiated the JE vaccination campaign followed by a JE vaccine introduction program in Bali Province in 2018. The JE vaccination program then has been fully integrated into the provincial routine immunization program since 2019. We conducted a retrospective economic analysis of JE vaccination program in Bali Province, Indonesia; considering multiple vaccination strategies.

Methods: We conducted a cost-effectiveness analysis using a decision analytic model comparing two vaccination strategies with no vaccination from the societal and government perspectives. These vaccination strategies were: (1) JE vaccination campaign and introduction program, and (2) a routine JE vaccination program. We compared costs and outcomes for three hypothetical cohorts of 100,000 children followed from birth to the age of 10 years, with impacts measured throughout the child's life-time. We measured the economic consequences as costs per case, per death, and per disability-adjusted life year (DALY) averted.

Results: A routine JE immunization program was the most cost-effective strategy with a cost per DALYs averted of US$ 212.59 and US$ 94.09 from the government and societal perspectives respectively. In contrast, costs per DALYs averted through the JE vaccination campaign and introduction strategy was US$ 1,473.53 and US$ 1,224.20 from the government and societal perspectives respectively.

Conclusions: Both JE vaccination strategies are cost-effective but they are not cost-saving when compared to no immunization program.

Keywords: Bali; Cost-effectiveness analysis; Economic evaluation; Immunization; Indonesia; Japanese encephalitis; Vaccination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Encephalitis, Japanese* / epidemiology
Encephalitis, Japanese* / prevention & control
Humans
Immunization Programs
Indonesia / epidemiology
Retrospective Studies
Vaccination