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Struckmann V, Stephani V, Hsiao A, Mbbando D, Changalucha J, Baisley K, Levin A, Hutubessy R, Watson-Jones D, Quentin W. Costs of delivering human papillomavirus vaccination in Tanzania. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cervical cancer caused by human papillomavirus (HPV) is the most frequent cancer in women in many low-income countries.Tanzania implemented a national HPV vaccination program in 2018 using a two-dose quadrivalent HPV vaccine. This study aimed to (1) estimate financial and economic costs of a two-dose vaccination program based on experiences with the national vaccination program, (2) estimate costs of a one-dose vaccination schedule to enable future cost-effectiveness analyses, and (3) assess the effect of alternative assumptions for future vaccination coverage rates on estimated costs of vaccination.
Methods
The WHO Cervical Cancer Prevention and Control Costing (C4P) tool was used to estimate the incremental costs of the national vaccination programme from the perspective of the Tanzanian government using data collected via surveys, workshops, and interviews with local stakeholders. Deterministic sensitivity analyses were performed to estimate the effect of alternative assumptions for coverage rates and delivery strategies and to assess the impact of a potential one-dose vaccination schedule.
Results
The total financial and economic costs were US$10,117,455 and US$45,683,204, respectively, at a financial cost of $5.17 per two-dose fully immunized girl (FIG), and an economic cost of $23.34 per FIG. Under the assumption of a one-dose vaccination schedule, costs per FIG would reduce to financial costs of $2.51 and economic costs of $12.18.
Conclusions
The overall cost of Tanzania’s HPV vaccination program was lower per vaccinee than previous demonstration projects in the region suggest. These data provide important baseline data for Tanzania’s HPV vaccination program to date and may serve as a guide for improving coverage going forward. The findings may also aid in the prioritization of funding for countries that have not yet added HPV vaccines to their routine immunizations.
Key messages
• If a single dose regimen were found to be as effective as a two-dose series, it would result in significant cost savings as well as an increase in the number of girls that could be reached.
• School-based vaccinations resulted in the lowest price per fully immunized girl, but other settings are needed to achieve equitable high coverage of HPV vaccination in Tanzania.
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Affiliation(s)
| | - V Stephani
- HelloBetter , Berlin, Germany
- TU Berlin, Berlin, Germany
| | | | - D Mbbando
- Mwanza Intervention Trials Unit , Mwanza, Tanzania
| | | | | | - A Levin
- Levin & Morgan, Bethesda, USA
| | - R Hutubessy
- Immunization, Vaccines and Biologicals Department, WHO , Geneva, Switzerland
| | - D Watson-Jones
- Mwanza Intervention Trials Unit , Mwanza, Tanzania
- LSHTM, London, UK
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2
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Prudden HJ, Hasso-Agopsowicz M, Black RE, Troeger C, Reiner RC, Breiman RF, Jit M, Kang G, Lamberti L, Lanata CF, Lopman BA, Ndifon W, Pitzer VE, Platts-Mills JA, Riddle MS, Smith PG, Hutubessy R, Giersing B. Meeting Report: WHO Workshop on modelling global mortality and aetiology estimates of enteric pathogens in children under five. Cape Town, 28-29th November 2018. Vaccine 2020; 38:4792-4800. [PMID: 32253097 PMCID: PMC7306158 DOI: 10.1016/j.vaccine.2020.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline. The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based. Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.
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Affiliation(s)
- H J Prudden
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - M Hasso-Agopsowicz
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - R E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R F Breiman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - M Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, National Infections Service, Public Health England, United Kingdom; School of Public Health, University of Hong Kong, Hong Kong
| | - G Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - L Lamberti
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - C F Lanata
- Instituto de Investigacion Nutricional, Lima, Peru; Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN 37027, USA
| | - B A Lopman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - W Ndifon
- African Institute for Mathematical Sciences, Cape Town, South Africa
| | - V E Pitzer
- Department of Epidemiology and Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - J A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - M S Riddle
- Uniformed Services University, Bethesda, MD 120814, USA
| | - P G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - R Hutubessy
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - B Giersing
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland.
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Newall AT, Jit M, Hutubessy R. Authors' reply to Gandjour: "Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines". Pharmacoeconomics 2014; 32:1247. [PMID: 25374292 DOI: 10.1007/s40273-014-0232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A T Newall
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW, 2052, Australia,
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Ultsch B, Damm O, Beutels P, Bilcke J, Brüggenjürgen B, Gerber-Grote AU, Greiner W, Hanquet G, Harder T, Hutubessy R, Jit M, Knol M, Kuhlmann A, von Kries R, Levy-Bruhl D, Perleth M, Postma MJ, Salo H, Siebert U, Wasem J, Weidemann F, Wichmann O. Methods for Health Economic Evaluations of Vaccines - Results from an International Expert-Workshop. Value Health 2014; 17:A552. [PMID: 27201800 DOI: 10.1016/j.jval.2014.08.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- B Ultsch
- Robert Koch Institute / Charité University Medical Center, Berlin, Germany
| | - O Damm
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - P Beutels
- University of Antwerp, Antwerp, Belgium
| | - J Bilcke
- University of Antwerp, Antwerp, Belgium
| | | | - A U Gerber-Grote
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - W Greiner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - G Hanquet
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - T Harder
- Robert Koch Institute, Berlin, Germany
| | - R Hutubessy
- World Health Organization, Geneva, Switzerland
| | - M Jit
- London School of Hygiene and Tropical Medicine / Public Health England (PHE), London, UK
| | - M Knol
- RIVM - Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - A Kuhlmann
- Leibniz Universität Hannover, Hannover, Germany
| | - R von Kries
- Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - D Levy-Bruhl
- Institut de Veille Sanitaire, Saint-Maurice Cedex, France
| | - M Perleth
- Gemeinsamer Bundesausschuss (G-BA), Berlin, Germany
| | - M J Postma
- University of Groningen, Groningen, The Netherlands
| | - H Salo
- National Institute for Health and Welfare, Helsinki, Finland
| | - U Siebert
- Medical Informatics and Technology, and Director of the Division for Health Technology Assessment and Bioinformatics, ONCOTYROL, Hall i. T, Austria
| | - J Wasem
- University of Duisburg-Essen, Essen, Germany
| | - F Weidemann
- Robert Koch Institute / Charité Berlin, Berlin, Germany
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Van der Putten IM, Hiligsmann M, Paulus ATG, Hutubessy R, Evers SM. Identifying the Broader Value of Vaccines in Low and Middle Income Countries. Value Health 2014; 17:A548. [PMID: 27201777 DOI: 10.1016/j.jval.2014.08.1783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - M Hiligsmann
- Maastricht University, Maastricht, The Netherlands
| | - A T G Paulus
- Maastricht University, Maastricht, The Netherlands
| | - R Hutubessy
- World Health Organization, Geneva, Switzerland
| | - S M Evers
- Maastricht University, Maastricht, The Netherlands
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Newall AT, Jit M, Hutubessy R. Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines. Pharmacoeconomics 2014; 32:525-31. [PMID: 24791735 DOI: 10.1007/s40273-014-0162-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.
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Affiliation(s)
- A T Newall
- Faculty of Medicine, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia,
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Niessen LW, Dijkstra R, Hutubessy R, Rutten GEHM, Casparie AF. Lifetime health effects and costs of diabetes treatment. Neth J Med 2003; 61:355-64. [PMID: 14768718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the treatment of complications, each at current care level and according to the guidelines. METHODS A validated probabilistic diabetes model describes diabetes and its complications over a lifetime in the Dutch population, computing quality-adjusted life years and medical costs. Effectiveness data and costs of diabetes interventions are from observational current care studies and intensive care experiments. Lifetime consequences of in total sixteen intervention mixes are compared with a baseline glycaemic control of 10% HBA1C. RESULTS The interventions may reduce the cumulative incidence of blindness, lower-extremity amputation, and end-stage renal disease by >70% in primary care and >60% in secondary care. All primary care guidelines together add 0.8 quality-adjusted life years per lifetime. CONCLUSION In case of few resources, treating complications according to guidelines yields the most health benefits. Current care of diabetes complications is inefficient. If there are sufficient resources, countries may implement all guidelines, also on diabetes control, and improve efficiency in diabetes care.
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Affiliation(s)
- L W Niessen
- Institute of Medical Technology Assessment, Erasmus Medical Centre, Erasmus University of Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
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Indaratna K, Hutubessy R, Chupraphawan S, Sukapurana C, Tao J, Chunsutthiwat S, Thimasarn K, Crissman L. Application of geographical information systems to co-analysis of disease and economic resources: dengue and malaria in Thailand. Southeast Asian J Trop Med Public Health 1998; 29:669-84. [PMID: 10772545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Two vector-borne communicable diseases, malaria and dengue, are among a number of diseases of particular importance in relation to economic development in Southeast Asia and thus need to be assessed in relation to economic parameters in the region. Geographical Information Systems (GIS) provide one means of comparing disease and resource data versus time and place, to facilitate rapid visualization by planners and administrators. Given that Thailand is a global epicenter of multidrug resistant falciparum malaria and of dengue hemorrhagic fever, both of which are mosquito-borne, application of GIS methods to these two diseases gives opportunity for comparison of resource needs and allocation in relation to disease epidemiologic patterns. This study examined per capita gross provincial product (GPPpc) and health care resources in relation to geographic distribution of malaria and dengue in Thailand. The two diseases vary greatly in overall seasonal patterns and in relation to provincial economic status, and present differing demands on resource utilization: planned integration of control of malaria and dengue could utilize such analyses in relation to resource sharing and consideration of allocative efficiency. The concentration of malaria (and to a lesser extent dengue) along international border areas underscores the desirability of multi-country coordination of disease management and control programs. Because socio-economic and disease data are collected by quite different means and in different time frames, there are some limitations to the dynamic interpolation of these two broad data sets, but useful inferences can be drawn from this approach for application to overall planning, at both national and multi-country levels.
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Affiliation(s)
- K Indaratna
- WHO Collaborating Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand.
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