Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda |
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| Institution: | 1. Office of Science and Integrated Programs, Centers for Disease Control and Prevention, Atlanta, GA, United States;2. IHRC Inc, Atlanta, GA, United States;3. Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, United States;4. Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;5. Kilembe Mines Hospital, Kasese, Uganda;6. Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States;1. Department of Sustainable Development, Appalachian State University, ASU Box 32080, Boone, NC 28608, USA;2. Department of Environmental and Global Health, University of Florida, 1225 Center Drive, Room 4160, Gainesville, FL 32610, USA;3. Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL 32610, USA;4. PATH, Center for Vaccine Innovation and Access, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA;5. Expanded Programme on Immunization, Ministry of National Health Services, Punjab Province, Pakistan;1. Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, POB 21, 00014 Helsinki, Finland;2. Department of Medicine, Division of Infectious Diseases, Helsinki University Hospital POB 348, 00029 Helsinki, Finland;3. Department of Medical Microbiology and Immunology, University of Turku, Kiinamyllynkatu 13, 20520 Turku, Finland;4. Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, Stockholm, Sweden;5. Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden;6. Department of Medicine, University of Helsinki, POB 20, 00014 Helsinki, Finland;7. Aava Travel Clinic, Medical Centre Aava, Helsinki, Finland;1. School of Public Health, Mongolian National University of Medical Science, Rm. 334, Sukhbaatar District, S. Zorig Street, Ulaanbaatar, Mongolia;2. PATH, Rue de Varembé 7, 1202 Geneva, Switzerland;3. London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom;4. World Health Organization Representative Office Mongolia, Government Building VIII, Olympic Street 2, Sukhbaatar District, Ulaanbaatar 14210, Mongolia;5. National Center for Communicable Disease, Ministry of Health, Government Building VIII, Olympic Street 2, Sukhbaatar District, Ulaanbaatar 14210, Mongolia;6. PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA;7. Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom;2. Public Health Foundation of India, New Delhi, India;3. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;4. Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control, Atlanta, GA;1. Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso;2. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA |
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| Abstract: | BackgroundVaccination has been increasingly promoted to help control epidemic and endemic typhoid fever in high-incidence areas. Despite growing recognition that typhoid incidence in some areas of sub-Saharan Africa is similar to high-incidence areas of Asia, no large-scale typhoid vaccination campaigns have been conducted there. We performed an economic evaluation of a hypothetical one-time, fixed-post typhoid vaccination campaign in Kasese, a rural district in Uganda where a large, multi-year outbreak of typhoid fever has been reported.MethodsWe used medical cost and epidemiological data retrieved on-site and campaign costs from previous fixed-post vaccination campaigns in Kasese to account for costs from a public sector health care delivery perspective. We calculated program costs and averted disability-adjusted life years (DALYs) and medical costs as a result of vaccination, to calculate the cost of the intervention per DALY and case averted.ResultsOver the 3 years of projected vaccine efficacy, a one-time vaccination campaign was estimated to avert 1768 (90%CI: 684–4431) typhoid fever cases per year and a total of 3868 (90%CI: 1353–9807) DALYs over the duration of the immunity conferred by the vaccine. The cost of the intervention per DALY averted was US$ 484 (90%CI: 18–1292) and per case averted US$ 341 (90%CI: 13–883).ConclusionWe estimated the vaccination campaign in this setting to be highly cost-effective, according to WHO's cost-effective guidelines. Results may be applicable to other African settings with similar high disease incidence estimates. |
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| Keywords: | Typhoid Typhoid vaccination Uganda Cost-effectiveness |
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