Introduction
Methods
Ethics statement
Population and setting
Data collection aspects
Measurement of cholera costs to the household and health facility
Measurement of immunization costs
Data management and analysis
Treatment costs of cholera to households and health facilities
Immunization costs and unit delivery costs per fully vaccinated person
Cost-effectiveness evaluation
Indirect effects of vaccine
Cost-effectiveness model input parameters
Central | Uncertainty | Source of data | Assumptions | |
---|---|---|---|---|
Parameters | value | range | Central value | Uncertainty ranges (min – max) |
Economic data | ||||
Vaccine purchase price per fully immunized, 2016 US$ | 3.7 | – | Derived from the analysis | – |
Vaccine delivery cost per fully immunized, 2016 US$ | 3.6 | [1.1–3.6] | Ilboudo et al. 2017 [14] | |
Cost of cholera to patients and households, 2016 US$ | 65.6 | [43.0–134.0] | Ilboudo et al. 2017 [15] | |
Cost of cholera to health facilities, 2016 US$ | 59.7 | [30.0–61.0] | Ilboudo et al. 2017 [15] | |
GDP per capita, 2016 US$ | 372.0 | – | World Bank 2017 [31] | – |
Discount rate (%) | 3.0 | [1.0–5.0] | WHO 2008 [30] | (Min and max from WHO, 2008 [30]) |
Epidemiological data | ||||
Cholera incidence (Inc, cases per 1,000) | 4.0 | [3.0–5.0] | Sauvageot et al. 2017 [32] | (Min and max from Sauvageot et al. 2017 [32]) |
Case fatality rate (CFR, %) | 2.6 | [1.4–6.7] | M’Bangombé, 2017 [33] | (Min and max from M’Bangombé, 2017 [33]) |
Vaccine protective duration (Dur, years) | 5.0 | [3.0–5.0] | Bhattacharya et al. 2013 [9] | (Min and max from Bhattacharya et al. 2013 [9]) |
Length of illness (Length, days) | 5.0 | [4.0–7.0] | Ilboudo et al. 2017 [15] | |
DALY weight (DALY weight) | 0.2 | [0.1–0.3] | Salomon et al. 2012 [36] | (Min and max from Salomon et al. 2012 [36]) |
Vaccine Efficacy (VEff, no indirect protection) | 58.0 | [42.0–69.0] | Bi et al. 2017 [35] | (Min and max from Bi et al. 2017 [35]) |
Vaccine Efficacy (VEff, with indirect protection) | 93.0 | [82.0–99.0] | Longini et al. 2007 [24] | (Min and max from Longini et al. 2007 [24]) |
Campaign coverage rate (%, without indirect protection) | 58.0 | [53.0–91.0] | MSF 2016 [4] | (Min and max from MSF, 2016 [34]) |
Demographic | ||||
Population | 90 000.0 | – | – | – |
Life expectancy at infection (LExp, years) | 58.0 | [50.0–60.0] | WHO, 2016 [37] | (Min and Max from WHO, 2016 [37]) |
Economic parameters
Vaccine effects
Demographic data
Results
Cost-effectiveness outcomes
Parameters | Base case | With indirect protection |
---|---|---|
Effects | ||
Total number of non-fatal cases averted | 619 | 993 |
Total number of deaths averted | 17 | 27 |
Total number of cases averted | 636 | 1 020 |
Total DALYs averted | 430 | 690 |
Costs | ||
Immunization program costs | 397 358 | 397 358 |
Total costs averted (households plus health facilities) | 79 789 | 127 938 |
Net program costs | 317 569 | 269 420 |
Cost-effectiveness ratios | ||
Net cost per death averted | 19 212 | 10 165 |
Net cost per case averted | 500 | 264 |
Net cost per DALY averted | 738 | 391 |
Vaccine requirements | ||
Doses per death averted | 6 631 | 4 136 |
Doses per case averted | 172 | 108 |
GDP thresholds | ||
Very cost-effective (GDP/capita) | 372 | 372 |
Cost-effective (3*GDP/capita) | 1116 | 1116 |