KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; UNICEF Health Section, Programme Division, New York, NY, USA.
Lancet Glob Health. 2019 May;7(5):e644-e654. doi: 10.1016/S2214-109X(18)30562-X.
BACKGROUND: In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. METHODS: In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). FINDINGS: We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130-25 256) deaths and 101 513 (4386-196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70-411) in 2032. INTERPRETATION: Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. FUNDING: Wellcome Trust and Gavi, the Vaccine Alliance.
背景：2009 年，全球疫苗免疫联盟（Gavi）、世界银行和捐赠方启动了肺炎球菌疫苗预先市场承诺，这有助于各国获得更负担得起的肺炎球菌疫苗。随着许多低收入国家开始达到从 Gavi 支持过渡到自筹资金的门槛（人均国民总收入三年平均值为 1580 美元），它们将需要考虑是继续全额支付肺炎球菌结合疫苗（PCV）费用，还是停止在儿童免疫规划中使用 PCV。本文以肯尼亚为例，评估了继续使用 PCV 的增量成本效益。
方法：在这项建模和成本效益研究中，我们根据肯尼亚基利菲的年度带菌流行率调查和侵袭性肺炎球菌病（IPD）发病率，拟合了肺炎球菌传播的动态隔室模型。我们预测了继续使用 PCV 超过 2022 年（肯尼亚开始脱离 Gavi 支持的时间）或停止使用 PCV 的情况下的疾病发病率和相关死亡率。我们计算了每例残疾调整生命年（DALY）的节省成本及其相关 95%预测区间（PI）。
结果：我们预测，如果肯尼亚在 2022 年停止使用 PCV，整体 IPD 发病率将从 2022 年的每 10 万人 8.5 例上升到 2032 年的每年每 10 万人 16.2 例。在此期间，继续接种疫苗将预防 14329 例（95%PI6130-253256）死亡和 101513 例（4386-196674）疾病。与停止接种疫苗相比，2022 年后继续使用 PCV 每年将需要额外估计 1530 万美元。我们预测，2032 年继续使用 PCV 预防每例 DALY 的增量成本将为 153 美元（95%PI70-411）。
解释：继续使用 PCV 是维持其健康效益的关键。基于肯尼亚人均国内生产总值为 1445 美元，与其他疫苗相比，全额支付 PCV 费用是具有成本效益的（假设疾病减少将转化为死亡率降低）。尽管负担能力可能是一个问题，但我们的研究结果支持肯尼亚扩大疫苗预算。
资金来源：惠康信托基金会和全球疫苗免疫联盟（Gavi）。
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