TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Currently employed at Sanofi Pasteur, Singapore, Singapore.
BMC Med. 2021 Feb 26;19(1):60. doi: 10.1186/s12916-021-01932-7.
Despite recent advances through the development pipeline, how novel tuberculosis (TB) vaccines might affect rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is unknown. We investigated the epidemiologic impact, cost-effectiveness, and budget impact of hypothetical novel prophylactic prevention of disease TB vaccines on RR/MDR-TB in China and India.
We constructed a deterministic, compartmental, age-, drug-resistance- and treatment history-stratified dynamic transmission model of tuberculosis. We introduced novel vaccines from 2027, with post- (PSI) or both pre- and post-infection (P&PI) efficacy, conferring 10 years of protection, with 50% efficacy. We measured vaccine cost-effectiveness over 2027-2050 as USD/DALY averted-against 1-times GDP/capita, and two healthcare opportunity cost-based (HCOC), thresholds. We carried out scenario analyses.
By 2050, the P&PI vaccine reduced RR/MDR-TB incidence rate by 71% (UI: 69-72) and 72% (UI: 70-74), and the PSI vaccine by 31% (UI: 30-32) and 44% (UI: 42-47) in China and India, respectively. In India, we found both USD 10 P&PI and PSI vaccines cost-effective at the 1-times GDP and upper HCOC thresholds and P&PI vaccines cost-effective at the lower HCOC threshold. In China, both vaccines were cost-effective at the 1-times GDP threshold. P&PI vaccine remained cost-effective at the lower HCOC threshold with 49% probability and PSI vaccines at the upper HCOC threshold with 21% probability. The P&PI vaccine was predicted to avert 0.9 million (UI: 0.8-1.1) and 1.1 million (UI: 0.9-1.4) second-line therapy regimens in China and India between 2027 and 2050, respectively.
Novel TB vaccination is likely to substantially reduce the future burden of RR/MDR-TB, while averting the need for second-line therapy. Vaccination may be cost-effective depending on vaccine characteristics and setting.
尽管通过研发管道取得了最近的进展，但新的结核病 (TB) 疫苗可能会对利福平耐药和耐多药结核病 (RR/MDR-TB) 产生何种影响尚不清楚。我们研究了假设的新型预防性疾病结核病疫苗对中国和印度 RR/MDR-TB 的流行病学影响、成本效益和预算影响。
我们构建了一个确定性的、分隔的、按年龄、耐药性和治疗史分层的结核病动态传播模型。我们从 2027 年开始引入新疫苗，具有 post- (PSI) 或 pre- 和 post-infection (P&PI) 功效，提供 10 年的保护，效力为 50%。我们衡量了 2027-2050 年疫苗的成本效益，以美元/残疾调整生命年 (DALY) 计算，与 1 倍 GDP/人均相比，以及两个基于医疗保健机会成本 (HCOC) 的阈值。我们进行了情景分析。
到 2050 年，P&PI 疫苗将中国和印度的 RR/MDR-TB 发病率分别降低 71%（UI：70-72）和 72%（UI：70-74），PSI 疫苗分别降低 31%（UI：30-32）和 44%（UI：42-47）。在印度，我们发现 10 美元的 P&PI 和 PSI 疫苗在 1 倍 GDP 和较高 HCOC 阈值以及 P&PI 疫苗在较低 HCOC 阈值下均具有成本效益。在中国，两种疫苗在 1 倍 GDP 阈值下均具有成本效益。如果概率为 49%，则 P&PI 疫苗在较低 HCOC 阈值下仍具有成本效益，如果概率为 21%，则 PSI 疫苗在较高 HCOC 阈值下具有成本效益。在 2027 年至 2050 年期间，P&PI 疫苗预计在中国和印度分别避免 0.900 万（UI：0.800-1.100）和 1.100 万（UI：0.900-1.400）二线治疗方案。
新型结核病疫苗很可能会大大减少 RR/MDR-TB 的未来负担，同时避免二线治疗的需要。疫苗的成本效益可能取决于疫苗的特点和环境。
