Optimizing immunization schedules in endemic cholera regions: cost-effectiveness assessment of vaccination strategies for cholera control in Bangladesh

Wu Zeng; Yujie Cui; Eva Jarawan; Carlos Avila; Guohong Li; Vincent Turbat; Jennifer Bouey; Marwa Farag; Ronald Mutasa; Haksoon Ahn; Daxin Sun; Jie Shen

doi:10.1016/j.vaccine.2021.09.044

Optimizing immunization schedules in endemic cholera regions: cost-effectiveness assessment of vaccination strategies for cholera control in Bangladesh

Vaccine. 2021 Oct 15;39(43):6356-6363. doi: 10.1016/j.vaccine.2021.09.044. Epub 2021 Sep 25.

Authors

Wu Zeng¹, Yujie Cui², Eva Jarawan³, Carlos Avila⁴, Guohong Li⁵, Vincent Turbat⁶, Jennifer Bouey⁷, Marwa Farag⁸, Ronald Mutasa⁹, Haksoon Ahn¹⁰, Daxin Sun¹¹, Jie Shen¹²

Affiliations

¹ Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA. Electronic address: wz192@georgetown.edu.
² Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China. Electronic address: cuiyujie@sjtu.edu.cn.
³ Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA. Electronic address: ej206@georgetown.edu.
⁴ Palladium Group, London, UK. Electronic address: Carlos.Avila@thepalladiumgroup.com.
⁵ Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China. Electronic address: guohongli@sjtu.edu.cn.
⁶ Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA. Electronic address: vmt24@georgetown.edu.
⁷ Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA. Electronic address: zh34@georgetown.edu.
⁸ School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Doha, Qatar. Electronic address: marwa.farag@usask.ca.
⁹ The World Bank Group, Washington DC, USA. Electronic address: rmutasa@worldbank.org.
¹⁰ School of Social Work, University of Maryland, Baltimore, MD, USA. Electronic address: Hahn@ssw.umaryland.edu.
¹¹ College of Transportation and Civil Engineering, Fujian Agriculture and Forestry University, Fuzhou, China. Electronic address: ffcsdx@126.com.
¹² Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China. Electronic address: shenjie@shsmu.edu.cn.

PMID: 34579976
DOI: 10.1016/j.vaccine.2021.09.044

Abstract

This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1-4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination.The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1-4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings.

Keywords: Bangladesh; Cholera; Cost-effectiveness analysis; Vaccine.

MeSH terms

Administration, Oral
Bangladesh / epidemiology
Child
Cholera Vaccines*
Cholera* / epidemiology
Cholera* / prevention & control
Cost-Benefit Analysis
Humans
Immunization Schedule
Vaccination

Substances

Cholera Vaccines