Evaluation of targeted mass cholera vaccination strategies in Bangladesh: a demonstration of a new cost-effectiveness calculator.
Bottom Line: Growing interest in mass vaccination with oral cholera vaccine in endemic and epidemic settings will require policymakers to evaluate how to allocate these vaccines in the most efficient manner.Because cholera, when treated properly, has a low case fatality rate, it may not be economically feasible to vaccinate an entire population.The approach described here is general enough to adapt to different settings or to other vaccine-preventable diseases.
Affiliation: Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Show MeSH
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Mentions: Children in Bangladesh have a higher incidence of cholera than adults (Table 1). Figure 3 shows the cost-effectiveness of targeting different age groups for vaccination. Vaccinating children from 1 to 4 years of age in the high-risk districts costs < $500 per DALY averted and is very cost-effective (Figures 1 and 3A) when vaccine efficacy is 65%. The costs per DALY averted is higher in school-aged children (5–14 years of age), but it is still cost-effective to vaccinate these age groups ($1,678/DALY). Vaccinating adults (15 years and older) is not cost-effective in this scenario (Figure 3A). Vaccinating children 1–14 years of age, is more cost-effective ($1,034/DALY) than vaccinating adults ($4,275/DALY) because children have higher cholera incidence than adults and averting cholera-related deaths in children averts more years of life lost.26 However, some studies have found that OCV has lower efficacy in children than adults.28,29 Even when vaccine efficacy is only 42% among children 1–4 years of age, vaccinating this age group is still cost-effective ($769/DALY averted) (Figure 3B).
Affiliation: Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.