A health benefit and cost-effectiveness analysis of pneumococcal conjugate vaccination program in Nigeria

Authors

  • Israel O. Idris Department of Disease Control, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom Department of Public Administration, Kharkiv National University of Economics, Kharkiv, Ukraine
  • Okiki O. Badejo Department of Public Health, Institute of Tropical Medicine (ITM) Antwerp, University of Antwerp, Belgium
  • Victor Ochagu Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
  • Sheriff A. Lamidi Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
  • Nataliia Gavkalova Department of Public Administration, Kharkiv National University of Economics, Kharkiv, Ukraine

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20200415

Keywords:

Cost-effectiveness analysis, Economic evaluation, Health benefit, Pneumococcal conjugate vaccine, Nigeria

Abstract

Background: Nigeria ranks third just behind India and China in the global disease burden of pneumococcal disease. The current sustainability approach for an affordable pneumococcal conjugate vaccine (PCV) for the national immunization program from 2014 till 2025 involves a cost sharing plan funded with a 75% financial support from GAVI and a subsidy from Pfizer pharmaceuticals. There is a strong need to generate evidence on the cost-effectiveness of the national PCV program in Nigeria from 2014-2025 and beyond 2025.

Methods: The following parameters (demography, disease burden, health services utilization and costs, vaccination coverage, vaccine efficacy, and vaccination costs) were used in a static cohort model to estimate the total cost, health and economic benefit, and cost-effectiveness of the implementation of PCV vaccination program, compared with no PCV vaccination among under-five children in Nigeria from 2014-2025 and from 2026-2033. A sensitivity analysis was conducted to evaluate the robustness of the data used.

Results: The national PCV vaccination program would have an approximated 31.4% and 30% reduction of the total burden of pneumococcal diseases over the period of 2014-2025 and 2026-2033 respectively. One-way sensitivity analysis reveals vaccine efficacy as most sensitive parameter followed by disease incidence rate and treatment cost. Removal and addition of DTP3 and 3+1 (measles vaccine) dose respectively resulted to a similar ICER from both.

Conclusions: The estimated ICER suggests that the national PCV program in Nigeria will be cost-effective post 2025 era.  In addition, it is recommended for policy-makers adoption considering the budget and equity impact of the intervention in Nigeria.

References

Stop Pneumonia. THE PIECE The Missing Piece Why continued neglect of pneumonia threatens the achievement of health goals. New York; 2018.

Iliyasu G, Habib AG, Borodo MM, Babashani M, Ahmed M. Pneumococcal infection in Nigeria: Preparing for the vaccine. Sub-Saharan African J Med. 2014;1(1):15.

Macfarlane JT, Adegboye DS, Warrell MJ. Mycoplasma pneumoniae and the aetiology of lobar pneumonia in northern Nigeria. Thorax. 1979;34(6):713-9.

Iliyasu G, Mohammad FD, Habib AG. Community acquired pneumococcal pneumonia in North western Nigeria: epidemiology, antimicrobial resistance and outcome. African J Infect Dis. 2018;12(1):15-9.

Laxminarayan R, Klugman KP. Communicating trends in resistance using a drug resistance index. BMJ Open. 2011;1(2):e000135.

Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet (London, England). 2016;387(10014):168-75.

Low DE, Pichichero ME, Schaad UB. Optimizing antibacterial therapy for community-acquired respiratory tract infections in children in an era of bacterial resistance. Clin Pediatr (Phila). 2004;43(2):135-51.

Pumart P, Phodha T, Thamlikitkul V, Arthorn Riewpaiboon PP. Health and economic impacts of antimicrobial resistance in Thailand. J Heal Serv Res Policy. 2012;352-60.

Chen C, Cervero Liceras F, Flasche S, Sidharta S, Yoong J, Sundaram N, et al. Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis. Lancet Glob Heal. 2019;7(1):e5867.

UNICEF Supply Division. Pneumococcal Conjugate Vaccine: Supply and amp; Demand Update; 2016.

UNICEF- supply. PCV price update. 2019. Available at: https://www.unicef.org/supply/index_ 102225.html. Accessed 12 November 2019.

Decision Letter Nigeria PCV Switch 2018. 2018. Available at: https://www.gavi.org/sites/default/ files/document/decision-letter-nigeria-pcv-sw. Accessed 12 November 2019.

Nigeria: Gavi support documents - Proposals, reports, plans, decision letters. Available at: https://www.gavi.org/country-documents/nigeria. Accessed 12 November 2019.

UNIVAC. Introduction to the UNIVAC Decision Support Model - Transcript. 2019:1-8.

Tan-Torres Edejer TR, Baltussen Ta R, Hutubessy A, Acharya Dbea CJL, Murray. WHO guide to cost-effectiveness analysis. Geneva; 2003.

Polinder S, Toet H, Panneman M, Van Beeck E. Methodological approaches for cost-effectiveness and cost-utility analysis of injury prevention measures. 2011.

Jit M, Mibei W. Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review. Vaccine. 2015;33(32):3788-94.

Attema AE, Brouwer WBF, Claxton K. Discounting in economic evaluations. Pharmaco. 2018;36(7):745-58.

Central Bank of Nigeria: Exchange Rate 2017. Arch. 2017. Available at: https://www.cbn.gov.ng/ rates/ExchangeArchives.asp. Accessed 12 November 2019.

Official exchange rate (LCU per US$, period average). Data. 2017. Available at: https://data.worldbank.org/indicator/PA.NUS.FCRF. Accessed 12 November 2019.

United nations des/population division. World Population Prospects - Population Division - United Nations.

WHO. Metrics: Disability-Adjusted Life Year (DALY). WHO. 2014. Available at: https://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/. Accessed 12 November 2019.

Vučina VV, Filipović SK, Kožnjak N, Stamenić V, Clark AD, Mounaud B, et al. Cost-effectiveness of pneumococcal conjugate vaccination in Croatia. Vaccine. 2015;33:A209-18.

Mihigo R, Okeibunor J, Masresha B, Mkanda P, Poy A, Zawaira F, et al. Immunization and vaccine development: Progress towards High and Equitable Immunization Coverage in the Africa Region. J Immunol Sci. 2018;Suppl(1):1-9.

Nigerian National Routine Immunization Strategic Plan(2013-2015). Available at: http://www.nitag-resource.org/media-center/document/752. Accessed 12 November 2019.

National Primary Health Care, Development Agency FM of H. Comprehensive EPI Multi-Year Plan 2016-2020. 2016.

Sarley D, Mahmud M, Idris J, Osunkiyesi M, Dibosa-Osadolor O, Okebukola P, et al. Transforming vaccines supply chains in Nigeria. Vaccine. 2017;35(17):2167-74.

GAVI. Factsheet Vaccine Pricing: GAVI Transitioning Countries. 2019. Available at: https://www.who.int/immunization/programmes_systems/procurement/mi4a/platform/module2/Factsheet_vacc_pricing_Gavi_transitioning_2016.pdf. Accessed 12 November 2019.

Monasta L, Ronfani L, Marchetti F, Montico M, Brumatti L, Bavcar A, et al. Burden of disease caused by otitis media: Systematic review and global estimates. PLoS One. 2012;7(4).

Planning N. Nigeria - Multiple Indicator Cluster Survey (MICS5) 2016-17, Fifth round. 2018;1-40.

Wahl B, O’Brien KL, Greenbaum A, Majumder A, Liu L, Chu Y, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Heal. 2018.

Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(5):317-28.

World health organization. Global burden of disease 2004 update: disability weights for diseases and conditions. 2004.

Onwujekwe O, Uguru N, Etiaba E, Chikezie I, Uzochukwu B, Adjagba A. The economic burden of malaria on households and the health system in Enugu State Southeast Nigeria. Fernandez-Reyes D, editor. PLoS One. 2013;8(11):e78362.

Ezeoke OP, Onwujekwe OE, Uzochukwu BS. Towards Universal Coverage: Examining Costs of Illness, Payment, and Coping Strategies to Different Population Groups in Southeast Nigeria. Am J Trop Med Hyg. 2012;86(1):52.

Okediji PT, Ojo AO, Ojo AI, Ojo AS, Ojo OE, Abioye-Kuteyi EA. The economic impacts of chronic illness on households of patients in ile-ife, South-Western Nigeria. Cureus. 2017;9(10):e1756.

Sambo MN, Ejembi CL, Adamu YM, Aliyu AA. Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria. J Community Med Primary Health Care. 2004;16(1):29-32.

Musa BM, John D, Habib AG, Kuznik A. Cost-optimization in the treatment of multidrug resistant tuberculosis in Nigeria. Trop Med Int Heal. 2016;21(2):176-82.

WHO. Nigeria: WHO and UNICEF estimates of immunization coverage: 2018 revision. 2019;1-30. Available at: https://www.who.int/immunization/ monitoring_surveillance/data/phl.pdf. Accessed 12 November 2019.

Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RAN, Nohynek H, et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev. 2009;(4).

Woods B, Revill P, Sculpher M, Claxton K. Country-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research. Value Health. 2016;19(8):929-35.

National Bureau of Statistics of Nigeria UNCF. Multiple Indicator Cluster Survey 2016-2017. World Bank. 2017.

Krishnamoorthy Y, Eliyas SK, Nair NP, Sakthivel M, Sarveswaran G, Chinnakali P. Impact and cost effectiveness of pneumococcal conjugate vaccine in India. Vaccine. 2019;37(4):623-30.

Kieninger MP, Caballero EG, Sosa AA, Amarilla CT, Jáuregui B, Janusz CB, et al. Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay. Vaccine. 2015;33:A143-53.

Mezones-Holguin E, Canelo-Aybar C, Clark AD, Janusz CB, Jaúregui B, Escobedo-Palza S, et al. Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru. Vaccine. 2015;33:A154-66.

Komakhidze T, Hoestlandt C, Dolakidze T, Shakhnazarova M, Chlikadze R, Kopaleishvili N, et al. Cost-effectiveness of pneumococcal conjugate vaccination in Georgia. Vaccine. 2015;33:A219-26.

Downloads

Published

2020-01-28

How to Cite

Idris, I. O., Badejo, O. O., Ochagu, V., Lamidi, S. A., & Gavkalova, N. (2020). A health benefit and cost-effectiveness analysis of pneumococcal conjugate vaccination program in Nigeria. International Journal Of Community Medicine And Public Health, 7(2), 463–474. https://doi.org/10.18203/2394-6040.ijcmph20200415

Issue

Section

Original Research Articles