Phillips, Maile TT, Antillon, Marina, Bilcke, Joke, Bar-Zeev, Naor, Limani, Fumbani, Debellut, Frederic, Pecenka, Clint, Neuzil, Kathleen MM, Gordon, Melita AA 
ORCID: 0000-0002-0629-0884, Thindwa, Deus et al (show 3 more authors)
(2023)
Cost-effectiveness analysis of typhoid conjugate vaccines in an outbreak setting: a modeling study.
BMC INFECTIOUS DISEASES, 23 (1).
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Abstract
<h4>Background</h4>Several prolonged typhoid fever epidemics have been reported since 2010 throughout eastern and southern Africa, including Malawi, caused by multidrug-resistant Salmonella Typhi. The World Health Organization recommends the use of typhoid conjugate vaccines (TCVs) in outbreak settings; however, current data are limited on how and when TCVs might be introduced in response to outbreaks.<h4>Methodology</h4>We developed a stochastic model of typhoid transmission fitted to data from Queen Elizabeth Central Hospital in Blantyre, Malawi from January 1996 to February 2015. We used the model to evaluate the cost-effectiveness of vaccination strategies over a 10-year time horizon in three scenarios: (1) when an outbreak is likely to occur; (2) when an outbreak is unlikely to occur within the next ten years; and (3) when an outbreak has already occurred and is unlikely to occur again. We considered three vaccination strategies compared to the status quo of no vaccination: (a) preventative routine vaccination at 9 months of age; (b) preventative routine vaccination plus a catch-up campaign to 15 years of age; and (c) reactive vaccination with a catch-up campaign to age 15 (for Scenario 1). We also explored variations in outbreak definitions, delays in implementation of reactive vaccination, and the timing of preventive vaccination relative to the outbreak.<h4>Results</h4>Assuming an outbreak occurs within 10 years, we estimated that the various vaccination strategies would prevent a median of 15-60% of disability-adjusted life-years (DALYs). Reactive vaccination was the preferred strategy for WTP values of $0-300 per DALY averted. For WTP values > $300, introduction of preventative routine TCV immunization with a catch-up campaign was the preferred strategy. Routine vaccination with a catch-up campaign was cost-effective for WTP values above $890 per DALY averted if no outbreak occurs and > $140 per DALY averted if implemented after the outbreak has already occurred.<h4>Conclusions</h4>Countries for which the spread of antimicrobial resistance is likely to lead to outbreaks of typhoid fever should consider TCV introduction. Reactive vaccination can be a cost-effective strategy, but only if delays in vaccine deployment are minimal; otherwise, introduction of preventive routine immunization with a catch-up campaign is the preferred strategy.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Typhoid fever, Reactive vaccination, Preventive vaccination, Typhoid conjugate vaccines, Economic evaluation |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 17 Mar 2023 10:50 |
| Last Modified: | 31 Mar 2023 10:17 |
| DOI: | 10.1186/s12879-023-08105-2 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3169139 |
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