Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option
Co-authors: Kinley Dorji, Sonam Phuntsho, Suthasinee Kumluang, Sarayuth Khuntha, Wantanee Kulpeng, Sneha Rajbhandari, Yot Teerawattananon
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Introduction: Despite high disease burden PCV introduction is limited in many low-income countries due to the competing health priorities and limited resources. Ministry of Health, Royal Government of Bhutan felt a need for evidence on cost and benefit of introducing PCV in the routine immunization program. Objective: To determine the Cost-Utility of introducing PCV10 and PCV13 in Bhutan compared to no vaccination. Methodology: A Markov model was used to estimate the costs and outcomes of three options in a government perspective cost-utility-analysis: PCV 10, PCV 13 and No PCV for a lifetime horizon. Discount rate at 3% per annum was applied. Health outcomes were measured in terms of pneumococcal-episode and death averted, and Quality-Adjusted-Life-Year (QALY) gained. Results are presented using an incremental cost-effectiveness ratio (ICER) per QALY gained. One-Way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty. Results. Compared to no vaccination, PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained, respectively. And PCV13 produced an ICER of USD 92 compared with PCV10. Inclusion of PCV into the routine immunization program would increase the 5-year budgetary requirement to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6–1.1 FTE) and nurse (1–1.6 FTE). Conclusion: The study recommends the introduction of PCV routine immunization program as both PCVs are cost-effective at the suggested threshold of one-time GDP per-capita (USD 2708). However, the implementation of PCV-13 would able to save more lives and costs in the long run.