Sibak Mohammed, Moussa Ibrahim, El-Tantawy Nasr, Badr Shaza, Chaudhri Irtaza, Allam Essam, Baxter Louise, Abo Freikha Saiyed, Hoestlandt Céline, Lara Carlos, Hajjeh Rana, Munier Aline
Expanded Program on Immunization, Ministry of Health, Egypt.
World Health Organization, Country Office, Egypt.
Vaccine. 2015 May 7;33 Suppl 1:A182-91. doi: 10.1016/j.vaccine.2014.12.044.
Pneumonia is one of the most important causes of morbidity and mortality in children under 5 in Egypt, and the Ministry of Health of Egypt is considering introducing pneumococcal conjugate vaccine (PCV) in its national immunization program. We performed an economic analysis to evaluate the cost-effectiveness of this vaccine in Egypt and to provide the decision-makers with needed evidence.
The analysis was done using the TRIVAC model. Data included demographic characteristics, burden of disease, coverage and efficacy of the vaccine, health resource utilization, and costs of pneumococcal disease vaccination and treatment. Whenever possible, we used national or regional data. Two alternatives were compared: (1) general vaccination of children younger than 5 years with the 13-valent pneumococcal conjugate vaccine (PCV13), using a three-dose schedule without booster, and (2) no vaccination. Outcomes of 10 cohorts from birth to 5 years were analyzed. The study was performed from the governmental perspective and selected public health providers.
In comparison to no vaccine, the introduction of PCV13 would be cost-effective, with an incremental cost-effectiveness ratio of US$ 3916 per disability-adjusted life-year (DALY) averted (government perspective). The total incremental cost of the PCV vaccination program (10 cohorts) would be approximately US$ 1.09 billion. Over the 10 cohorts, the program would avert 8583 pneumococcal deaths - 42% of all pneumococcal-related deaths.
The introduction of PCV13 would be a good value for money from the government perspective. It would represent a high-impact public health intervention for Egypt and respond to the National Immunization Technical Advisory Group (NITAG) resolution on reducing pneumonia burden and overall child mortality. Strengthening surveillance will be critical to generating high-quality national data, improving future economic analyses that support evidence-based decisions for introducing vaccines and public health interventions, and to monitoring their impact.
肺炎是埃及5岁以下儿童发病和死亡的最重要原因之一，埃及卫生部正在考虑将肺炎球菌结合疫苗（PCV）纳入其国家免疫规划。我们进行了一项经济分析，以评估该疫苗在埃及的成本效益，并为决策者提供所需证据。
使用TRIVAC模型进行分析。数据包括人口统计学特征、疾病负担、疫苗的覆盖率和效力、卫生资源利用情况以及肺炎球菌疾病疫苗接种和治疗的成本。只要有可能，我们就使用国家或地区数据。比较了两种方案：（1）对5岁以下儿童使用13价肺炎球菌结合疫苗（PCV13）进行常规接种，采用三剂次接种程序且不进行加强接种；（2）不接种疫苗。分析了从出生到5岁的10个队列的结果。该研究是从政府角度并选取公共卫生服务提供者进行的。
与不接种疫苗相比，引入PCV13具有成本效益，每避免一个伤残调整生命年（DALY）的增量成本效益比为3916美元（政府角度）。PCV疫苗接种计划（10个队列）的总增量成本约为10.9亿美元。在这10个队列中，该计划将避免8583例肺炎球菌死亡——占所有肺炎球菌相关死亡的42%。
从政府角度来看，引入PCV13将物有所值。它将是埃及一项具有重大影响的公共卫生干预措施，并符合国家免疫技术咨询小组（NITAG）关于减轻肺炎负担和降低儿童总体死亡率的决议。加强监测对于生成高质量的国家数据、改进未来支持引入疫苗和公共卫生干预措施的循证决策的经济分析以及监测其影响至关重要。
