Table 2.
Cost-effectiveness analysis of vaccination assuming baseline infection risk and the use of amphotericin B
| Vaccination cost | $5 | $30 | $100 | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Vaccine efficacy | 25% | 50% | 75% | 25% | 50% | 75% | 25% | 50% | 75% |
| VL cases (per 1,000 people) | |||||||||
| No vaccination | 805* (804–805) | 805 (804–805) | 805 (805–805) | 805 (804–805) | 805 (804–805) | 805 (804–806) | 805 (804–805) | 805 (804–805) | 805 (804–806) |
| Vaccination | 724 (723–725) | 589 (589–590) | 368 (368–369) | 724 (723–725) | 590 (589–590) | 368 (367–368) | 724 (723–725) | 590 (589–590) | 407 (367–653) |
| Cases averted | 81† (80–82) | 216 (215–216) | 437 (436–437) | 81 (80–81) | 215 (215–216) | 437 (436–438) | 81 (80–81) | 215 (215–216) | 398 (152–438) |
| PKDL cases (per 1,000 people) | |||||||||
| No vaccination | 197 (196–198) | 197 (196–199) | 197 (196–198) | 197 (196–198) | 197 (196–199) | 197 (196–199) | 197 (196–199) | 197 (196–199) | 197 (196–199) |
| Vaccination | 177 (176–178) | 144 (143–145) | 90 (89–91) | 177 (176–178) | 144 (143–145) | 90 (89–90) | 177 (176–179) | 144 (143–145) | 99 (89–160) |
| Cases averted | 20 (19–21) | 53 (52–54) | 107 (107–108) | 20 (19–21) | 53 (52–54) | 108 (107–109) | 20 (19–20) | 53 (25–54) | 98 (37–108) |
| Cost, US$ (per 1,000 people) | |||||||||
| No vaccination | 134,131‡ (107,567–160,835) | 133,937 (107,342–160,679) | 134,033 (107,305–160,721) | 134,029 (107,448–160,713) | 133,926 (107,134–160,785) | 134,077 (107,133–160,846) | 134,054 (107,561–160,669) | 134,034 (107,372–160,737) | 137,027 (107,290–160,891) |
| Vaccination | 117,465 (95,111–139,853) | 101,107 (82,042–120,103) | 78,562 (63,930–93,023) | 136,899 (95,113–164,651) | 126,143 (107,061–145,314) | 103,485 (88,827–118,018) | 191,356 (95,113–234,843) | 196,239 (177,025–215,282) | 179,418 (158,843–207,436) |
| Cost averted | 16,666 (12,254–21,203) | 32,829 (25,301–40,586) | 55,470 (42,966–67,867) | −2,870 (−12,199–12,462) | 7,783 (−170–15,873) | 30,592 (18,028–42,998) | −57,301 (−81,914–12,462) | −62,205 (−69,817–−54,505) | −42,391 (−72,904–−27,125) |
| DALYs (per 1,000 people) | |||||||||
| No vaccination | 8,420 (8,208–8,644) | 8,416 (8,221–8,646) | 8,426 (8,213–8,637) | 8,434 (8,198–8,651) | 8,414 (8,198–8,646) | 8,413 (8,188–8,612) | 8,423 (8,215–8,632) | 8,415 (8,202–8,629) | 8,438 (8,168–8,637) |
| Vaccination | 8,296 (8,085–8,507) | 8,091 (7,994–8,243) | 7,767 (7,677–7,848) | 8,300 (8,093–8,509) | 8,060 (7,888–8,227) | 7,764 (7,679–7,864) | 8,297 (8,096–8,482) | 8,072 (7,918–8,232) | 7,826 (7,675–8,215) |
| DALYs averted | 124 (89–174) | 326 (227–426) | 659 (512–799) | 134 (89–183) | 354 (270–447) | 648 (505–777) | 126 (89–167) | 344 (271–456) | 613 (195–830) |
| ICER | Vaccine§ | Vaccine | Vaccine | 126 (20–461) | Vaccine | Vaccine | 757 (445–1,606) | 190 (120–258) | 65 (33–105) |
*
Mean (95% range). Interval was not listed where both values were equal to the mean after rounding.
†
Calculations done from the table values may be slightly off because of rounding.
‡
Negative costs are costly, positive costs are cost saving.
§
“Vaccine” indicates combinations of vaccination cost and efficacy where vaccination was less costly and more effective than no vaccination under all minor side effect and treatment seeking probability conditions explored.
PKDL = post kala-azar dermal leishmaniasis; DALYs = disability adjusted life years; ICER = incremental cost-effectiveness ratio.