DOMI Cholera Economics Study Group: B. Maskery, MS, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; D. Lauria, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; J. Stewart, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; M. Lucas, MS, Ministry of Science and Technology, Maputo, Mozambique; Z. Islam, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; R. Malik, National Institute of Health Research and Development, Jakarta, Indonesia; M. Najib, National Institute of Health Research and Development, Jakarta, Indonesia; S. Chatterjee, National Institute of Cholera and Enteric Diseases, Kolkata, India.
Cost-Effectiveness of New-Generation Oral Cholera Vaccines: A Multisite Analysis
Article first published online: 8 MAY 2009
© 2009, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
Value in Health
Volume 12, Issue 6, pages 899–908, September 2009
How to Cite
Jeuland, M., Cook, J., Poulos, C., Clemens, J., Whittington, D. and DOMI Cholera Economics Study Group (2009), Cost-Effectiveness of New-Generation Oral Cholera Vaccines: A Multisite Analysis. Value in Health, 12: 899–908. doi: 10.1111/j.1524-4733.2009.00562.x
- Issue published online: 24 JUL 2009
- Article first published online: 8 MAY 2009
- herd protection;
Objectives: We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects.
Methods: Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older.
Results: We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates.
Conclusions: Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.