Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi


Madsen, LB; Ustrup, M; Hansen, KS; Nyasulu, PS; Bygbjerg, IC; Konradsen, F; (2014) Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi. Tropical medicine & international health, 19 (2). pp. 177-185. ISSN 1360-2276 DOI: https://doi.org/10.1111/tmi.12233

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Abstract

ObjectivesWorldwide, rotavirus infections cause approximately 453000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost. MethodsFollowing the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis. ResultsThe total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components. ConclusionThe total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing. ObjectifsDecrire le profil des patients et les resultats des traitements, y compris les rechutes, chez les patients atteints de la leishmaniose viscerale (LV) traites par l'amphotericine B liposomale (AmBisome) a Gedaref, au Soudan. MethodesAmBisome a ete offert a deux groupes de patients: ceux avec une LV primaire selon des criteres precis (age 2 ou 45 ans, maladie clinique avancee, grossesse, coinfection avec le VIH et contre-indications aux derives de l'antimoine) et ceux avec des rechutes de LV. AmBisome a ete administre a une dose totale de 30mg/kg, durant 10 jours. Les repondants lents ont recu jusqu'a 50mg/kg. L'echec du traitement a ete confirme par la parasitologie. Les resultats du traitement standardise ont ete evalues. ResultatsEntre mars 2010 et juin 2012, un total de 281 (74%) patients atteints de LV primaire et 98 (26%) cas de rechutes LV ont recu AmBisome (54% d'hommes, age median = 11 ans, intervalle interquartile 2-30). Les resultats de fin de traitement pour la LV primaire etaient de 260 (92%) guerisons initiales, comprenant 3 (1%) repondants lents, 3 (1%) echecs de traitement, 14 (5%) deces et 4 (1%) resultat inconnus. Les resultats pour les cas de rechutes LV etaient de 92 (94%) guerisons initiales, comprenant 5 (5%) repondants lents, 4 (4%) echecs de traitement, 1 (1%) deces et 1 (1%) resultat inconnu. 6 mois, il y avait 19 (7%) cas de rechutes parmi les cas de VL primaire et 10 (10%) cas de rechutes LV avaient une nouvelle rechute. Les pertes au suivi dans les deux groupes etaient de 38%. Aucun des deces survenus au cours de la periode d'etude n'a ete attribue a AmBisome. ConclusionAmBisome semble etre efficace pour la guerison initiale de la LV et le medicament semble sur, mais il est couteux (400 USD/traitement). Des mecanismes durables permettant un meilleur acces a ce medicament couteux, en particulier en Afrique orientale, sont urgemment necessaires. Les rechutes et les pertes au suivi necessitent une recherche specifique. ObjetivosReportar el perfil de los pacientes y los resultados del tratamiento, incluidas las recaidas, de la leishmaniasis visceral (LV) en pacientes tratados con anfotericina B liposomal (AmBisome) en Gedaref, Sudan. MetodosSe ofrecio AmBisome a dos grupos de pacientes: pacientes con LV primaria con criterios especificos (edad 2 o45 anos, enfermedad clinica avanzada, embarazo, coinfeccion con VIH y contraindicaciones para antimoniales) y recaidas de LV. Se dio AmBisome en una dosis total de 30mg/kg, durante 10 dias. Los respondedores lentos recibieron hasta 50mg/kg. El fallo en el tratamiento se confirmo mediante examen parasitologico. Se evaluaron los resultados del tratamiento estandar. ResultadosEntre Marzo 2010 y Junio 2012, un total de 281 (74%) pacientes con LV primaria y 98 (26%) con recaidas de LV recibieron AmBisome (54% hombres, edad media=11 anos, rango intercuartil 2-30). Los resultados del final del tratamiento para LV primaria fueron de 260 (92%) curaciones iniciales -incluyendo 3 (1%) respondedores lentos, 3 (1%) fallos en el tratamiento, 14 (5%) muertes y 4 (1%) resultados desconocidos. Los resultados de recaidas de LV fueron de 92 (94%) curaciones iniciales - con 5 (5%) respondedores lentos, 4 (4%) fallos en el tratamiento, 1 (1%) muerte y 1 (1%) resultado desconocido. A los 6 meses, habia 19 (7%) recaidas entre LV primaria y 10 (10%) recaidas de LV tuvieron una nueva recaida. La perdida durante el seguimiento en ambos grupos era del 38%. Ninguna de las muertes que ocurrieron durante el periodo de estudio fue atribuida a AmBisome. ConclusionAmBisome parece ser efectivo para la curacion inicial de LV y la medicacion parece ser segura, pero es muy costosa (400 USD/tratamiento). Se requiere urgentemente de mecanismos sostenibles que permitan un acceso mejorado a este medicamento costoso en africa del Este. Las recaidas y la perdida durante el seguimiento requieren de investigacion especifica.

Item Type: Article
Keywords: Child, Cost-Benefit Analysis, Developing Countries, Humans, Immunization Programs, economics, Malawi, Rotavirus, immunology, Rotavirus Infections, economics, immunology, prevention & control, Rotavirus Vaccines, economics, immunology, Vaccination, economics, World Health Organization
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Leishmaniasis Group
PubMed ID: 24314006
Web of Science ID: 329822400008
URI: http://researchonline.lshtm.ac.uk/id/eprint/1620422

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