TY - JOUR
T1 - Sustaining pneumococcal vaccination after transitioning from Gavi support
T2 - a modelling and cost-effectiveness study in Kenya
AU - Ojal, John
AU - Griffiths, Ulla
AU - Hammitt, Laura L.
AU - Adetifa, Ifedayo
AU - Akech, Donald
AU - Tabu, Collins
AU - Scott, J. Anthony G.
AU - Flasche, Stefan
N1 - Funding Information:
JAGS received grants from Gavi, The Vaccine Alliance and the Wellcome Trust, during the conduct of the study; and grants from PATH Vaccine Solutions, outside the submitted work. LLH received research grants to her institution from GSK, Pfizer, and Merck, outside the submitted work. All other authors declare no competing interests.
Funding Information:
This paper is published with the permission of the Director, KEMRI. The work was funded by the Wellcome Trust through fellowship support to JO ( 092767 ) and JAGS ( 098532 ), and grant support for the Pneumococcal Conjugate Vaccine Impact Study from Gavi, the Vaccine Alliance ( SSC 1433 ). SF is supported through a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant Number 208812 ).
Publisher Copyright:
© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2019/5
Y1 - 2019/5
N2 - Background: In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. Methods: In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). Findings: We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130–25 256) deaths and 101 513 (4386–196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70–411) in 2032. Interpretation: Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. Funding: Wellcome Trust and Gavi, the Vaccine Alliance.
AB - Background: In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. Methods: In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). Findings: We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130–25 256) deaths and 101 513 (4386–196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70–411) in 2032. Interpretation: Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. Funding: Wellcome Trust and Gavi, the Vaccine Alliance.
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U2 - 10.1016/S2214-109X(18)30562-X
DO - 10.1016/S2214-109X(18)30562-X
M3 - Article
C2 - 31000132
AN - SCOPUS:85064121792
SN - 2214-109X
VL - 7
SP - e644-e654
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 5
ER -