Cost-Effectiveness of Rubella Vaccination: Informing Implementation in South Africa

Presenter: Ciaran Kohli-Lynch

Twitter: '@theceed

Co-authors: Heather Fraser, Ijeoma Edoka

Poster file: [download]
Background Rubella is a viral infection with a high prevalence in subsets of the South African population. Contracting rubella in childhood confers lifelong immunity and severe complications are rare in infected infants. However, congenital rubella syndrome (CRS) accounts for a high degree of morbidity and mortality in South Africa. CRS occurs when a developing foetus is exposed to the rubella virus. Reducing rubella transmission through vaccination programmes may help reduce rates of CRS in a population. However, if coverage rates of a rubella-containing vaccine (RCV) programme are not sufficiently high, the process of natural immunisation through childhood exposure can be interrupted with deleterious effects on population health. ‘Dynamic’ models are required to predict effectiveness of interventions affected by interaction between infectious and susceptible individuals. This study reviewed literature pertaining to the health economics of RCV implementation strategies to help inform decision-making in the South African public health sector. Methods Results of a dynamic ‘susceptible-infective-recovered’ modelling study of rubella vaccination were compared with South African data to estimate necessary RCV coverage rates to avoid long-term increases in CRS. Furthermore, a systematic literature review was conducted of cost-benefit, cost-effectiveness, and cost-utility analyses of RCV strategies. Included articles were read in full and information on their methods, key findings, setting, perspective, vaccination strategies, and type of analysis were extracted. These analyses both aimed to inform an ongoing cost-effectiveness analysis of RCV implementation in South Africa. Results Current levels of measles vaccination in South Africa may facilitate implementation of a successful RCV programme. 2 cost-utility analyses, 11 cost-benefit analyses, and 5 cost-effectiveness analyses of RCVs were identified in our review from a range of low- and middle-income countries. The results general supported implementation of RCV programmes. However, only one study employed a dynamic model and this study did not consider potential increases in CRS from RCV programmes with low coverage. Discussion There is a lack of cost-utility analyses of rubella-containing vaccinations. Additionally, existing economic evaluations employ static decision models which are unable to predict increases in CRS attributable to low coverage. An ongoing cost-effectiveness analysis will look to address these gaps in the literature.