Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam.
ThinkWell, Washington, DC, USA.
Glob Health Sci Pract. 2022 Apr 29;10(2). doi: 10.9745/GHSP-D-21-00482. Print 2022 Apr 28.
In 2017, aligned with global World Health Organization tetanus guidelines, Vietnam prepared evidence to support a recommendation to introduce the tetanus-diphtheria (Td) vaccine into routine immunization. This study aimed to provide evidence on the costs and budgetary impact of the potential replacement of the tetanus-toxoid (TT) vaccine with the Td vaccine, considering different possible delivery strategies.
We used an activity-based ingredients costing approach to estimate the 2017 program costs of providing TT vaccination to girls aged 15-16 years and conducting Td campaigns in outbreak areas. We performed a budget impact analysis for 2018-2025 using the cost per dose estimates based on the current delivery of these vaccines. We assumed complete cessation of TT vaccination of girls aged 15-16 years and a transition period where Td outbreak control campaigns would still occur. Td vaccine was assumed to be provided to children aged 7 years using either facility- or school-based delivery or combined facility- and school-based delivery.
The delivery cost per dose for current TT vaccination for girls aged 15-16 years was US$1.49 for school-based delivery, US$1.76 for facility-based delivery, and US$3.86 for delivery via outreach. Td vaccination through campaigns was estimated to cost US$3.56/dose. During 2018-2025, replacing the TT vaccine for girls aged 15-16 years with the Td vaccine for children aged 7 years is estimated to save US$4.61 million in immunization delivery costs if a school-based delivery strategy is used or US$1.04 million if facility-based delivery is used.
Compared to the current plan, delivery of Td routine vaccination via a school-based strategy was the most cost saving. These results were used in late 2019 to support the delivery of Td vaccination using a school-based delivery strategy for children aged 7 years in 30 Northern provinces in Vietnam.
2017 年，越南与全球世界卫生组织破伤风指导方针保持一致，为推荐引入破伤风类毒素-白喉（Td）疫苗纳入常规免疫准备了证据。本研究旨在提供关于用 Td 疫苗替代破伤风类毒素（TT）疫苗的潜在成本和预算影响的证据，同时考虑了不同的可能的交付策略。
我们使用基于活动的成分成本法来估算 2017 年为 15-16 岁女孩提供 TT 疫苗接种和在疫情地区开展 Td 运动的项目成本。我们根据当前疫苗的交付情况，使用每剂量成本估算值对 2018-2025 年进行了预算影响分析。我们假设完全停止为 15-16 岁女孩接种 TT 疫苗，并假设在 Td 疫情控制运动期间仍会进行过渡时期的接种。Td 疫苗被假设通过机构或学校为 7 岁儿童接种，或通过机构和学校联合提供。
目前为 15-16 岁女孩接种 TT 疫苗的每剂量接种费用分别为：学校接种 1.49 美元、机构接种 1.76 美元和外展接种 3.86 美元。通过运动接种 Td 的费用估计为 3.56 美元/剂。在 2018-2025 年期间，用 7 岁儿童的 Td 疫苗替代 15-16 岁女孩的 TT 疫苗，如果采用学校接种策略，预计在免疫接种交付成本方面可节省 461 万美元；如果采用机构接种策略，预计可节省 104 万美元。
与现行计划相比，采用学校接种策略接种 Td 常规疫苗在成本节约方面效果最佳。这些结果于 2019 年末用于支持在越南 30 个北部省份为 7 岁儿童采用学校接种策略接种 Td 疫苗。
