Cost-effectiveness and budget impact analyses of introducing typhoid conjugate vaccine into Indonesia’s national immunisation program

This peer-reviewed article in Vaccine assesses the cost-effectiveness and budget impact of introducing typhoid conjugate vaccine (TCV) into Indonesia’s National Immunisation Program (NIP), either through routine vaccination at 9 months of age or through routine vaccination combined with a catch-up campaign targeting children up to 15 years of age. The study uses a validated dynamic typhoid transmission model linked to an economic model, with a 30-year analytical horizon, country-specific cost-of-illness data and vaccine costing inputs. It estimates health outcomes and costs from both healthcare-sector and societal perspectives, reporting incremental cost-effectiveness ratios (ICERs) for each vaccination strategy and assessing uncertainty using one-way and probabilistic sensitivity analyses, alongside a six-year budget impact analysis.

Key findings

• Introducing routine Bio-TCV® vaccination at 9 months was projected to prevent approximately 1.48 million typhoid cases, 828,785 outpatient visits, 14,800 hospitalisations and 9,088 deaths over the 30-year analytical horizon, corresponding to 410,182 DALYs averted compared with no vaccination.
• Adding a catch-up campaign for children up to 15 years of age was projected to avert a further 1.10 million typhoid cases, 616,210 outpatient visits, 11,004 hospitalisations, 6,783 deaths and 326,475 DALYs compared with routine vaccination alone.
• From the societal perspective, the ICER for routine Bio-TCV® vaccination compared with no vaccination was US$238.8 per DALY averted, equivalent to approximately 5% of Indonesia’s GDP per capita. Adding the catch-up campaign to routine vaccination had an ICER of US$519.5 per DALY averted, or approximately 11% of GDP per capita.
• The six-year budget impact was estimated at US$61 million for routine vaccination alone and US$251 million for routine vaccination combined with the catch-up campaign. These corresponded to average annual shares of 1.88% and 7.76%, respectively, of the national immunisation budget over the period assessed.
• The results were robust to the uncertainty explored in the sensitivity analyses. At a willingness-to-pay threshold of one times GDP per capita. When all strategies were considered simultaneously, the routine-plus-catch-up strategy had a 97.0% probability of being the optimal strategy at this threshold.

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