Costeffectiveness of hepatitis B and Hib vaccines: information for advocacy

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Cost-effectiveness of hepatitis B and Hib
vaccines information for advocacy

• Rosamund Lewis
• Humphrey Karamagi

EPI Managers Meeting, Zanzibar, March 9, 2005
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Background

• DPT-HepB-Hib introduced in June 2002
• FS process started in October 2002
• Highlighted impact on Govt financing of new
  vaccine
• In-country discussion on if investment by Govt in
  new vaccine is equitable resource use
• Impact on disease priorities of the country
• FSP team recognized need to review impact and
  cost of vaccinating vs not vaccinating

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Policy question addressed

• What are the costs and implications of different
  policy options?
• a) DTP
• b) DTP-HepB,
• c) DTP-HepB-Hib, or
• d) DTP-Hib

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Process methods

• Basic premise
• Based on birth cohort of 2007, when GAVI phase I
  to end
• Total costs over the life of the cohort
• Health sector perspective, direct costs
• Burden of disease
• Cases, deaths and disability due to hepatitis B
  and Hib
• Hib disease associated with debilitating sequelae
• Review of total costs
• PHC costs to be incurred by health system
• Vaccine and treatment costs discounted to 2007
• Disability and rehabilitation not costed
• Cost-effectiveness indicators for hepatitis B and
  Hib

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Advocacy process continued

• Findings summarized in government policy brief
  during FSP development
• Extensive discussion between government and
  development partners
• Strongly led by EPI team
• Policy emphasis shifted from cost-effectiveness
  to affordability
• HSSPII (2005/6 2009/10) now considers 2
  scenarios realistic (hep B) and idealistic (Hib)

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Issues methods

• Decisions not based on vaccine cost alone (burden
  of disease and treatments savings taken into
  account)
• Conservative methods underestimate cost savings
  and disease burden
• Costs based on MOH impact, not society at large
• Actual practice (chlor and pen) vs. expected
  future practice (ceftriaxone)
• Have not accounted for cumulative benefit of
  protecting several cohorts

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Issues process

• Designed to provide information for policy
• Quick availability of findings to feed into
  discussion
• Decision makers needs not limited to CE
• Linked to budgeting constraints
• The least costly option does not result in the
  best outcomes for society
• Conflict between most cost-effective option and
  option most likely to have impact on child
  mortality (millenium development goals)
• Need framework for discussion of ethical issues

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Lessons learnt

• Information for policy useful when available
• Country needs to consider several options when
  making new vaccine policy decisions
• Methods and results need to be in form easily
  understood by policy-makers
• Question addressed Should we pay for this?
  doesnt answer proceeding question How do we
  pay for this?
• Vaccine industry and funding partners to consider
  vaccine price that makes product economically
  viable to countries