Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

Abstract

BackgroundThe World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective.Methodology/Principal FindingsPublic and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3).Conclusions/SignificanceBased on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness under certain circumstances, especially in high-incidence areas and at OCV prices below USD 1.3.

Systematic review of the economic value of diarrheal vaccines

“…This was in part a reflection of the high number of studies on rotavirus. Other studies considered targeted introduction in outbreak settings [21][22][23] or among travelers. 20,[24][25][26] The studies varied in what benefits were included in the analysis.…”

Inventory Management of Cholera Vaccinations in the Event of Complex Natural Disasters

“…According to Schaetti et al (2012), the cost to produce each dose of OCV is $10.00 and each person requires two doses. Schaetti et al (2012) also describes the ancillary costs associated with a mass vaccination campaign in Zanzibar, Africa. The details each cost is shown in Figure 20.…”

Economics and financing of vaccines for diarrheal diseases

“…38 Several studies have evaluated the cost of cholera illness in developing countries. [40][41][42][43] Economic burden: high income country A MEDLNE search found no studies evaluating the economic burden of cholera in developed countries. .…”

“…[43][44][45][46] One study evaluated different immunization strategies and looked at the impact of herd immunity, 44 while two studies evaluated the cost of a mass vaccination campaign -determining the total cost, cost per person (ranging from $3.93 to $30 per fully immunized person) and potential cost-savings. 43,46 These estimates varied with cost inclusions, for example $3.93 is for the vaccine only, while the $30 figure includes other components of the campaign (only 68% of this was vaccine cost).…”