Incremental cost-effectiveness of supplementary immunization to prevent neonatal tetanus in Pakistan

被引:0
作者
Griffiths, UK [1 ]
Wolfson, LJ
Quddus, A
Younus, M
Hafiz, RA
机构
[1] WHO, Dept Immunizat Vaccines & Biol, CH-1211 Geneva 27, Switzerland
[2] WHO, Expanded Programme Immunizat, Polio Eradicat Programme, Quetta, Pakistan
[3] UNICEF, Hlth & Nutr, Quetta, Pakistan
[4] NIH, Expanded Programme Immunizat, Islamabad, Pakistan
关键词
tetanus/prevention and control; infant; newborn; tetanus toxoid/administration and dosage/economics; immunization; secondary/economics; disability evaluation; costs and cost analysis; cost-benefit analysis; Pakistan;
D O I
暂无
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objective This study aimed to estimate the incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in the Loralai district of Pakistan. The supplemental immunization activities were carried out in two phases during 2001-03. Methods A state-transition model was used to estimate the effect of routine vaccination with tetanus toxoid as well as vaccination with tetanus toxoid during supplementary immunization activities. The model follows each woman in the target population from birth until the end of her childbearing years, using age-specific fertility data and vaccination history to determine the number of births at risk for neonatal tetanus. Recently published data on the incidence of neonatal tetanus from Loralai were used to determine the number of cases occurring with and without supplementary immunization activities. Data on the costs of the activities were collected from the UNICEF office in Balochistan and from the Provincial Health Department. Findings Using base-case assumptions we estimated that the supplementary immunization activities would prevent 280 cases of neonatal tetanus and 224 deaths from neonatal tetanus between 2001 and 2034. Implementation of the supplementary activities was relatively inexpensive. The cost per tetanus toxoid dose delivered was US$ 0.40. In the base-case analysis the cost per. death averted was US$ 117.00 (95% confidence interval (CI) = US$ 78-205) and the cost per disability-adjusted life year (DALY) averted was US$ 3.61 (95% CI = US$ 2.43-6.39). Conclusion Compared with similar analyses of other interventions, the cost per DALY averted is a favourable cost-effectiveness ratio. However, if routine diphtheria-tetanus-pertussis vaccination coverage in the Loralai district had been higher (at a coverage rate of about 80%) the cost-effectiveness of the intervention would have been even more favourable, at US$ 2.65 per DALY averted.
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页码:643 / 651
页数:9
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