Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa

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dc.contributor.authorChanning, Liezl
dc.contributor.authorSinanovic, Edina
dc.date.accessioned2015-07-30T03:57:03Z
dc.date.available2015-07-30T03:57:03Z
dc.date.issued2014-09-16
dc.date.updated2015-01-15T17:58:28Z
dc.description.abstractAbstract Background Tuberculosis remains the leading cause of death in South Africa. A number of potential new TB vaccine candidates have been identified and are currently in clinical trials. One such candidate is MVA85A. This study aimed to estimate the cost-effectiveness of adding the MVA85A vaccine as a booster to the BCG vaccine in children from the perspective of the South African government. Methods The cost-effectiveness was assessed by employing Decision Analytic Modelling, through the use of a Markov model. The model compared the existing strategy of BCG vaccination to a new strategy in which infants receive BCG and a booster vaccine, MVA85A, at 4 months of age. The costs and outcomes of the two strategies are estimated through modelling the vaccination of a hypothetical cohort of newborns and following them from birth through to 10 years of age, employing 6-monthly cycles. Results The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective – there are fewer TB cases and deaths from TB than BCG alone. The South African government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. The threshold analysis shows that, if the efficacy of the MVA85A vaccine was 41.3% (instead of the current efficacy of 17.3%), the two strategies would have the same cost but more cases of TB and more deaths from TB would be prevented by adding the MVA85A vaccine to the BCG vaccine. In this case, the government chould consider the MVA85A strategy. Conclusions At the current level of efficacy, the MVA85A vaccine is neither effective nor cost-effective and, therefore, not a good use of limited resources. Nevertheless, this study contributes to developing a standardized Markov model, which could be used, in the future, to estimate the potential cost-effectiveness of new TB vaccines compared to the BCG vaccine, in children between the ages of 0–10 years. It also provides an indicative threshold of vaccine efficacy, which could guide future development.
dc.identifier.apacitationChanning, L., & Sinanovic, E. (2014). Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa. <i>Cost Effectiveness and Resource Allocation</i>, http://hdl.handle.net/11427/13596en_ZA
dc.identifier.chicagocitationChanning, Liezl, and Edina Sinanovic "Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa." <i>Cost Effectiveness and Resource Allocation</i> (2014) http://hdl.handle.net/11427/13596en_ZA
dc.identifier.citationChanning, L., & Sinanovic, E. (2014). Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa. Cost Effectiveness and Resource Allocation, 12(1), 20.
dc.identifier.ris TY - Journal Article AU - Channing, Liezl AU - Sinanovic, Edina AB - Abstract Background Tuberculosis remains the leading cause of death in South Africa. A number of potential new TB vaccine candidates have been identified and are currently in clinical trials. One such candidate is MVA85A. This study aimed to estimate the cost-effectiveness of adding the MVA85A vaccine as a booster to the BCG vaccine in children from the perspective of the South African government. Methods The cost-effectiveness was assessed by employing Decision Analytic Modelling, through the use of a Markov model. The model compared the existing strategy of BCG vaccination to a new strategy in which infants receive BCG and a booster vaccine, MVA85A, at 4 months of age. The costs and outcomes of the two strategies are estimated through modelling the vaccination of a hypothetical cohort of newborns and following them from birth through to 10 years of age, employing 6-monthly cycles. Results The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective – there are fewer TB cases and deaths from TB than BCG alone. The South African government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. The threshold analysis shows that, if the efficacy of the MVA85A vaccine was 41.3% (instead of the current efficacy of 17.3%), the two strategies would have the same cost but more cases of TB and more deaths from TB would be prevented by adding the MVA85A vaccine to the BCG vaccine. In this case, the government chould consider the MVA85A strategy. Conclusions At the current level of efficacy, the MVA85A vaccine is neither effective nor cost-effective and, therefore, not a good use of limited resources. Nevertheless, this study contributes to developing a standardized Markov model, which could be used, in the future, to estimate the potential cost-effectiveness of new TB vaccines compared to the BCG vaccine, in children between the ages of 0–10 years. It also provides an indicative threshold of vaccine efficacy, which could guide future development. DA - 2014-09-16 DB - OpenUCT DO - 10.1186/1478-7547-12-20 DP - University of Cape Town J1 - Cost Effectiveness and Resource Allocation LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa TI - Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa UR - http://hdl.handle.net/11427/13596 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/13596
dc.identifier.urihttp://dx.doi.org/10.1186/1478-7547-12-20
dc.identifier.vancouvercitationChanning L, Sinanovic E. Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa. Cost Effectiveness and Resource Allocation. 2014; http://hdl.handle.net/11427/13596.en_ZA
dc.language.rfc3066en
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License*
dc.rights.holderChanning and Sinanovic; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0*
dc.sourceCost Effectiveness and Resource Allocationen_ZA
dc.source.urihttp://www.resource-allocation.com
dc.subject.otherCost-effectiveness analysisen_ZA
dc.subject.otherNew TB vaccineen_ZA
dc.subject.otherMarkov modellingen_ZA
dc.subject.otherChildhood TBen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherBCG vaccineen_ZA
dc.subject.otherHealth Economicsen_ZA
dc.titleModelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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