Academic journal article Bulletin of the World Health Organization

Economic Evaluation of Delivering Haemophilus Influenzae Type B Vaccine in Routine Immunization Services in Kenya/ Evaluation Economique De la Delivrance Du Vaccin Contre Haemophilus Influenzae Type B Par Les Services De Vaccination Systematique Du Kenya/ Evaluacion Economica De la Administracion De la Vacuna Contra Haemophilus Influenzae Tipo B En Los Servicios De Inmunizacion Sistematica De Kenya

Academic journal article Bulletin of the World Health Organization

Economic Evaluation of Delivering Haemophilus Influenzae Type B Vaccine in Routine Immunization Services in Kenya/ Evaluation Economique De la Delivrance Du Vaccin Contre Haemophilus Influenzae Type B Par Les Services De Vaccination Systematique Du Kenya/ Evaluacion Economica De la Administracion De la Vacuna Contra Haemophilus Influenzae Tipo B En Los Servicios De Inmunizacion Sistematica De Kenya

Article excerpt

Introduction

Haemophilus influenzae type b (Hib) vaccine has been licensed for use in infants since 1991. Most industrialized countries introduced the vaccine quickly into routine infant immunization services, This was justified by observed annual incidence rates of Hib meningitis between 20 and 69 cases per 100 000 children under five years old. (1) Middle-income and developing countries have been hesitant to introduce the vaccine because of its relatively high price and the problem of establishing the Hib disease burden in areas with very little surveillance. However, since 2001 the GAVI Alliance (previously the Global Alliance for Vaccines and Immunization) has provided financial support for new and underused vaccines in 72 low-income countries. (2) By July 2005, GAVI supported the introduction of Hib vaccine in 17 of these countries, usually delivered in combination with diphtheria-tetanus-pertussis (DTP) and hepatitis B vaccines as a pentavalent vaccine. (2)

Kenya was among the first nine countries to receive financial support from GAVI, and pentavalent vaccine was introduced nationwide in November 2001. GAVI's financial commitment for new vaccines in Kenya was US$ 67.4 million over a five-year period, (2) after which it was anticipated that the vaccine price would decrease substantially--an expectation yet to be realized. Support was planned to end in 2006, but recently GAVI offered to extend assistance through 2006-2015 with country co-financing. GAVI's phase II strategy is that recipient countries make progressive increases to their contributions to vaccine costs so that they reach market prices by 2016. (3) In 2007 the Kenyan Government agreed to co-finance the pentavalent vaccine with US$ 0.38 per dose for the period 2006-2011 (letter from Minister of Health to GAVI, 18 April 2007). Hib vaccination is a new cost item in the Kenyan Government's health budget; therefore cost-effectiveness evidence is likely to be crucial when deciding on future financial support. The objective of this study was to estimate the incremental costs per case, death and DALY, averted by delivering Hib vaccine in routine infant immunization services in Kenya.

Methods

A model was developed to follow the 2004 birth cohort until death. Two scenarios were constructed: one with Hib vaccine in routine immunization services and one without. Only immediate costs of care were estimated, excluding the costs of providing long-term care for patients with severe sequelae. The analysis was carried out from a public health provider perspective; costs incurred by households were not included. The 2004 average exchange rate of 79.49 Kenyan shillings to US$ I was used in all calculations. All future costs and outcomes were discounted at 3% per year.

Hib disease incidence

Pneumonia is the most common manifestation of Hib disease in developing countries. (4) Findings from Hib vaccine trials in the Gambia and Chile illustrate that reductions in radiologically proven pneumonia cases were approximately five times those in Hib meningitis cases. (5-7) However, difficulties in establishing a definitive diagnosis of Hib disease in most parts of the wodd mean that the true disease burden remains largely unknown. (4,8) Hib disease is divided into three categories in this study: (a) Hib meningitis, (b) non-meningitic invasive Hib disease (mainly bacteraemic Hib pneumonia, but also severe sepsis with an unknown focus of infection), and (c) non-bacteraemic Hib pneumonia.

Age-specific incidences of category (a) and (b) before and after the introduction of Hib vaccine were estimated from hospital admission records at Kilifi District Hospital (KDH) between 2000 and 2005. KDH is a rural government-funded hospital with 42 paediatric beds and approximately 5000 paediatric admissions per year. A Kenya Medical Research Institute (KEMRI) centre at the hospital has been conducting research on common childhood illnesses since 1989. …

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