Cost-benefit analysis of Haemophilus influenzae type b vaccination in children in Spain

Objective: Invasive disease caused by Haemophilus influenzae type b (Hib), including meningitis, pneumonia, sepsis and epiglottitis, is associated with high mortality and serious neurological sequelae in children under 5 years of age. The availability of an efficacious vaccine suggests the need to perform an economic evaluation of its use. The objective of this study was to evaluate the costs and benefits of introducing a universal vaccination programme for children under 1 year of age in Spain. Design & Setting: A cost-benefit analysis (CBA) was conducted over a 5-year period from the societal perspective in the Spanish healthcare setting. Both direct and indirect costs were included in the analysis [using 1996 Spanish pesetas (Pta); Pta 126.5 = $US1 in April 1996]. Patients and participants: The target population used for cost and benefit estimation was the 384 883 Spaniards aged 1 year or less in the last Spanish Population and Housing Census of 1991. Main outcome measures and results: The introduction of the universal Hib vaccination programme would imply vaccinating 346 395 children under 1 year of age, with a global expense of Pta2 444 855 910. For an average incidence of 15 cases of invasive disease per 100 000 children per year nationwide, the programme would prevent 219 cases of invasive disease and 8 deaths over a 5-year period, with a benefit of Pta2 182 868 907, a net benefit (i.e. benefit minus cost) of -Pta261 987 003, a benefit/cost ratio of 0.89 and a benefit per case prevented of -Pta1 196 288. Benefit/cost ratios above 1 would be obtained in the regions of highest incidence of invasive disease. Conclusion: The decision to implement a universal vaccination programme should not be based only on economic factors, but our results suggest that the economic returns of the programme for children under 1 year of age in Spain would be at least of a similar magnitude as its expenses.