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Published in: BMC Health Services Research 1/2020

Open Access 01-12-2020 | Polio Virus | Research article

Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine

Authors: Ignacio Olivera, Carlos Grau, Hugo Dibarboure, Juan Pablo Torres, Gustavo Mieres, Luis Lazarov, Fabián P. Alvarez, Juan Guillermo López Yescas

Published in: BMC Health Services Research | Issue 1/2020

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Abstract

Background

The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio ‘end-game’ strategy.

Methods

We analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26).

Results

The overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme.

Conclusions

The switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
Literature
1.
2.
go back to reference Barnighausen T, Berkley S, Bhutta ZA, Bishai DM, Black MM, Bloom DE, Constenla D, Driessen J, Edmunds J, Evans D, et al. Reassessing the value of vaccines. Lancet Glob Health. 2014;2(5):e251–2.CrossRef Barnighausen T, Berkley S, Bhutta ZA, Bishai DM, Black MM, Bloom DE, Constenla D, Driessen J, Edmunds J, Evans D, et al. Reassessing the value of vaccines. Lancet Glob Health. 2014;2(5):e251–2.CrossRef
3.
go back to reference Ozawa S, Stack ML, Bishai DM, Mirelman A, Friberg IK, Niessen L, Walker DG, Levine OS. During the 'decade of vaccines,’ the lives of 6.4 million children valued at $231 billion could be saved. Health Aff (Millwood). 2011;30(6):1010–20.CrossRef Ozawa S, Stack ML, Bishai DM, Mirelman A, Friberg IK, Niessen L, Walker DG, Levine OS. During the 'decade of vaccines,’ the lives of 6.4 million children valued at $231 billion could be saved. Health Aff (Millwood). 2011;30(6):1010–20.CrossRef
6.
go back to reference Greene SA, Ahmed J, Datta SD, Burns CC, Quddus A, Vertefeuille JF, Wassilak SGF. Progress toward polio eradication - worldwide, January 2017-March 2019. MMWR Morb Mortal Wkly Rep. 2019;68(20):458–62. Greene SA, Ahmed J, Datta SD, Burns CC, Quddus A, Vertefeuille JF, Wassilak SGF. Progress toward polio eradication - worldwide, January 2017-March 2019. MMWR Morb Mortal Wkly Rep. 2019;68(20):458–62.
7.
go back to reference Nielsen NM, Kay L, Wanscher B, Ibsen R, Kjellberg J, Jennum P. Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients. J Neurol. 2016;263(6):1120–8.CrossRef Nielsen NM, Kay L, Wanscher B, Ibsen R, Kjellberg J, Jennum P. Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients. J Neurol. 2016;263(6):1120–8.CrossRef
10.
go back to reference Lopalco PL. Wild and vaccine-derived poliovirus circulation, and implications for polio eradication. Epidemiol Infect. 2017;145(3):413–9.CrossRef Lopalco PL. Wild and vaccine-derived poliovirus circulation, and implications for polio eradication. Epidemiol Infect. 2017;145(3):413–9.CrossRef
11.
go back to reference Sutter RW, Platt L, Mach O, Jafari H, Aylward RB. The new polio eradication end game: rationale and supporting evidence. J Infect Dis. 2014;210(Suppl 1):S434–8.CrossRef Sutter RW, Platt L, Mach O, Jafari H, Aylward RB. The new polio eradication end game: rationale and supporting evidence. J Infect Dis. 2014;210(Suppl 1):S434–8.CrossRef
12.
go back to reference Pallansch MA. Ending use of Oral poliovirus vaccine - a difficult move in the polio endgame. N Engl J Med. 2018;379(9):801–3.CrossRef Pallansch MA. Ending use of Oral poliovirus vaccine - a difficult move in the polio endgame. N Engl J Med. 2018;379(9):801–3.CrossRef
17.
go back to reference Nunes MC, Madhi SA. Review of a new fully liquid, hexavalent vaccine: Hexaxim. Expert Opin Biol Ther. 2013;13(4):575–93.CrossRef Nunes MC, Madhi SA. Review of a new fully liquid, hexavalent vaccine: Hexaxim. Expert Opin Biol Ther. 2013;13(4):575–93.CrossRef
18.
go back to reference Maman K, Zollner Y, Greco D, Duru G, Sendyona S, Remy V. The value of childhood combination vaccines: from beliefs to evidence. Hum Vaccin Immunother. 2015;11(9):2132–41.CrossRef Maman K, Zollner Y, Greco D, Duru G, Sendyona S, Remy V. The value of childhood combination vaccines: from beliefs to evidence. Hum Vaccin Immunother. 2015;11(9):2132–41.CrossRef
19.
go back to reference Marshall GS, Happe LE, Lunacsek OE, Szymanski MD, Woods CR, Zahn M, Russell A. Use of combination vaccines is associated with improved coverage rates. Pediatr Infect Dis J. 2007;26(6):496–500.CrossRef Marshall GS, Happe LE, Lunacsek OE, Szymanski MD, Woods CR, Zahn M, Russell A. Use of combination vaccines is associated with improved coverage rates. Pediatr Infect Dis J. 2007;26(6):496–500.CrossRef
20.
go back to reference Kalies H, Grote V, Verstraeten T, Hessel L, Schmitt HJ, von Kries R. The use of combination vaccines has improved timeliness of vaccination in children. Pediatr Infect Dis J. 2006;25(6):507–12.CrossRef Kalies H, Grote V, Verstraeten T, Hessel L, Schmitt HJ, von Kries R. The use of combination vaccines has improved timeliness of vaccination in children. Pediatr Infect Dis J. 2006;25(6):507–12.CrossRef
21.
go back to reference Dodd D. Benefits of combination vaccines: effective vaccination on a simplified schedule. Am J Manag Care. 2003;9(1 Suppl):S6–12.PubMed Dodd D. Benefits of combination vaccines: effective vaccination on a simplified schedule. Am J Manag Care. 2003;9(1 Suppl):S6–12.PubMed
22.
go back to reference Koslap-Petraco MB, Judelsohn RG. Societal impact of combination vaccines: experiences of physicians, nurses, and parents. J Pediatr Health Care. 2008;22(5):300–9.CrossRef Koslap-Petraco MB, Judelsohn RG. Societal impact of combination vaccines: experiences of physicians, nurses, and parents. J Pediatr Health Care. 2008;22(5):300–9.CrossRef
25.
go back to reference Glassman A, Canon O, Silverman R. How to get cost-effectiveness analysis right? The case of vaccine economics in Latin America. Value Health. 2016;19(8):913–20.CrossRef Glassman A, Canon O, Silverman R. How to get cost-effectiveness analysis right? The case of vaccine economics in Latin America. Value Health. 2016;19(8):913–20.CrossRef
30.
go back to reference Decker MD, Edwards KM, Steinhoff MC, Rennels MB, Pichichero ME, Englund JA, Anderson EL, Deloria MA, Reed GF. Comparison of 13 acellular pertussis vaccines: adverse reactions. Pediatrics. 1995;96(3 Pt 2):557–66.PubMed Decker MD, Edwards KM, Steinhoff MC, Rennels MB, Pichichero ME, Englund JA, Anderson EL, Deloria MA, Reed GF. Comparison of 13 acellular pertussis vaccines: adverse reactions. Pediatrics. 1995;96(3 Pt 2):557–66.PubMed
31.
go back to reference Centres for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46(RR-7):1–25. Centres for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46(RR-7):1–25.
32.
go back to reference Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CR. Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children. Pediatrics. 1981;68(5):650–60.PubMed Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CR. Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children. Pediatrics. 1981;68(5):650–60.PubMed
33.
go back to reference De Coster I, Fournie X, Faure C, Ziani E, Nicolas L, Soubeyrand B, Van Damme P. Assessment of preparation time with fully-liquid versus non-fully liquid paediatric hexavalent vaccines. A time and motion study. Vaccine. 2015;33(32):3976–82.CrossRef De Coster I, Fournie X, Faure C, Ziani E, Nicolas L, Soubeyrand B, Van Damme P. Assessment of preparation time with fully-liquid versus non-fully liquid paediatric hexavalent vaccines. A time and motion study. Vaccine. 2015;33(32):3976–82.CrossRef
34.
go back to reference Arancel MAI. MINSAL Chile. In: Comprehensive medical consultation, Medium Complexity Hospital, Equivalent Emergency Service; 2018. Arancel MAI. MINSAL Chile. In: Comprehensive medical consultation, Medium Complexity Hospital, Equivalent Emergency Service; 2018.
35.
go back to reference Arancel MAI. MINSAL Chile. In: Hospitalization in Pediatric Intensive Care. 1.5 days, considering bed day price plus average attention involved (extrapolated from an influenza study); 2018. Arancel MAI. MINSAL Chile. In: Hospitalization in Pediatric Intensive Care. 1.5 days, considering bed day price plus average attention involved (extrapolated from an influenza study); 2018.
36.
go back to reference CENABAST. Central supply of the National System of health services (CENABAST). Chile: Ministry of Health; 2018. CENABAST. Central supply of the National System of health services (CENABAST). Chile: Ministry of Health; 2018.
39.
go back to reference Fagnani F, Le Fur C, Durand I, Gibergy M. Economic evaluation of a combined DTPa, hepatitis B, polio, Hib vaccine. Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule. Eur J Health Econ. 2004;5(2):143–9.CrossRef Fagnani F, Le Fur C, Durand I, Gibergy M. Economic evaluation of a combined DTPa, hepatitis B, polio, Hib vaccine. Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule. Eur J Health Econ. 2004;5(2):143–9.CrossRef
40.
go back to reference Mascareñas A, Salinas J, Tasset-Tisseau A, Mascarenas C, Khan MM. Polio immunization policy in Mexico: economic assessment of current practice and future alternatives. Public Health. 2005;119(6):542–9. Mascareñas A, Salinas J, Tasset-Tisseau A, Mascarenas C, Khan MM. Polio immunization policy in Mexico: economic assessment of current practice and future alternatives. Public Health. 2005;119(6):542–9.
41.
go back to reference Mogale K, Burnett RJ, Olivier D, Mphahlele J. Economic assessment of implementing Hexaxim® vaccine within the south African expanded Programme on immunisation (EPI-SA). Int J Infect Dis. 2014;21S:430.CrossRef Mogale K, Burnett RJ, Olivier D, Mphahlele J. Economic assessment of implementing Hexaxim® vaccine within the south African expanded Programme on immunisation (EPI-SA). Int J Infect Dis. 2014;21S:430.CrossRef
42.
go back to reference Jackson DW, Rohani P. Perplexities of pertussis: recent global epidemiological trends and their potential causes. Epidemiol Infect. 2014;142(4):672–84.CrossRef Jackson DW, Rohani P. Perplexities of pertussis: recent global epidemiological trends and their potential causes. Epidemiol Infect. 2014;142(4):672–84.CrossRef
43.
go back to reference Smallridge WE, Rolin OY, Jacobs NT, Harvill ET. Different effects of whole-cell and acellular vaccines on Bordetella transmission. J Infect Dis. 2014;209(12):1981–8.CrossRef Smallridge WE, Rolin OY, Jacobs NT, Harvill ET. Different effects of whole-cell and acellular vaccines on Bordetella transmission. J Infect Dis. 2014;209(12):1981–8.CrossRef
44.
go back to reference Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci U S A. 2014;111(2):787–92.CrossRef Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci U S A. 2014;111(2):787–92.CrossRef
45.
go back to reference Desai S, Schanzer DL, Silva A, Rotondo J, Squires SG. Trends in Canadian infant pertussis hospitalizations in the pre- and post-acellular vaccine era, 1981-2016. Vaccine. 2018;36(49):7568–73.CrossRef Desai S, Schanzer DL, Silva A, Rotondo J, Squires SG. Trends in Canadian infant pertussis hospitalizations in the pre- and post-acellular vaccine era, 1981-2016. Vaccine. 2018;36(49):7568–73.CrossRef
Metadata
Title
Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine
Authors
Ignacio Olivera
Carlos Grau
Hugo Dibarboure
Juan Pablo Torres
Gustavo Mieres
Luis Lazarov
Fabián P. Alvarez
Juan Guillermo López Yescas
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-05115-7

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