Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya.
Journal
The Lancet. Global health
ISSN: 2214-109X
Titre abrégé: Lancet Glob Health
Pays: England
ID NLM: 101613665
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
06
04
2018
revised:
03
12
2018
accepted:
06
12
2018
entrez:
20
4
2019
pubmed:
20
4
2019
medline:
26
5
2020
Statut:
ppublish
Résumé
In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130-25 256) deaths and 101 513 (4386-196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70-411) in 2032. Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. Wellcome Trust and Gavi, the Vaccine Alliance.
Sections du résumé
BACKGROUND
In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use.
METHODS
In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI).
FINDINGS
We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130-25 256) deaths and 101 513 (4386-196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70-411) in 2032.
INTERPRETATION
Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya.
FUNDING
Wellcome Trust and Gavi, the Vaccine Alliance.
Identifiants
pubmed: 31000132
pii: S2214-109X(18)30562-X
doi: 10.1016/S2214-109X(18)30562-X
pmc: PMC6484775
pii:
doi:
Substances chimiques
Pneumococcal Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e644-e654Subventions
Organisme : Wellcome Trust
ID : 098532
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 208812/Z/17/Z
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Références
N Engl J Med. 2005 Jan 6;352(1):39-47
pubmed: 15635111
Lancet. 2005 Mar 26-Apr 1;365(9465):1139-46
pubmed: 15794968
JAMA. 2006 Aug 9;296(6):671-8
pubmed: 16896110
BMC Public Health. 2006 Dec 29;6:314
pubmed: 17196105
Bull World Health Organ. 2007 Jul;85(7):511-8
pubmed: 17768499
Bull World Health Organ. 2008 May;86(5):332-8
pubmed: 18545734
Cost Eff Resour Alloc. 2009 Jan 22;7:3
pubmed: 19161598
Hum Vaccin. 2010 Mar 21;6(3):null
pubmed: 20009517
Lancet Infect Dis. 2010 May;10(5):317-28
pubmed: 20417414
Clin Infect Dis. 2010 Sep 15;51(6):692-9
pubmed: 20715907
Bull World Health Organ. 2011 Feb 1;89(2):102-11
pubmed: 21346921
Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12;366(1579):2841-9
pubmed: 21893549
PLoS One. 2012;7(10):e47511
pubmed: 23115650
PLoS One. 2013 Jun 24;8(6):e67324
pubmed: 23826268
Int J Public Health. 2014 Jun;59(3):565-9
pubmed: 24752429
Lancet Glob Health. 2014 Jul;2(7):e397-405
pubmed: 25103393
N Engl J Med. 2014 Nov 13;371(20):1889-99
pubmed: 25386897
Vaccine. 2015 May 28;33(23):2697-703
pubmed: 25865467
Bull World Health Organ. 2015 Feb 1;93(2):118-24
pubmed: 25883405
Lancet Respir Med. 2015 Jun;3(6):427
pubmed: 25995069
PLoS Med. 2015 Jun 09;12(6):e1001839
pubmed: 26057994
Lancet Glob Health. 2015 Nov;3(11):e712-23
pubmed: 26475018
Lancet Infect Dis. 2016 Jun;16(6):703-711
pubmed: 26897105
J Infect. 2016 Jul;73(1):18-27
pubmed: 27105658
BMC Health Serv Res. 2016 May 13;16:182
pubmed: 27177430
Clin Infect Dis. 2017 Jul 15;65(2):308-314
pubmed: 28605414
Vaccine. 2017 Aug 16;35(35 Pt B):4561-4568
pubmed: 28729018
Vaccine. 2017 Aug 16;35(35 Pt B):4652-4657
pubmed: 28739116
Influenza Other Respir Viruses. 2018 Jan;12(1):30-37
pubmed: 29243402
Lancet Infect Dis. 2018 Apr;18(4):441-451
pubmed: 29395999
Lancet Glob Health. 2019 Mar;7(3):e337-e346
pubmed: 30784634
Lancet. 2019 Apr 15;:null
pubmed: 31000194