Table 3.
Cost-effectiveness analysis of vaccination assuming 50% of baseline infection risk and the use of amphotericin B
| Vaccination cost | $5 | $30 | $100 | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Vaccine efficacy | 25% | 50% | 75% | 25% | 50% | 75% | 25% | 50% | 75% |
| VL cases (per 1,000 people) | |||||||||
| No vaccination | 589* (589–590) | 590 (589–591) | 590 (589–590) | 590 (589–590) | 590 (589–591) | 590 (589–590) | 590 (589–590) | 590 (589–590) | 590 (589–590) |
| Vaccination | 461 (264–493) | 368 (367–369) | 207 (206–208) | 461 (264–494) | 396 (367–494) | 207 (206–207) | 492 (492–493) | 368 (367–368) | 207 (206–207) |
| Cases averted | 129† (96–326) | 222 (221–223) | 383 (382–384) | 129 (96–326) | 194 (96–223) | 383 (382–384) | 97 (97–98) | 222 (221–223) | 383 (382–383) |
| PKDL cases (per 1,000 people) | |||||||||
| No vaccination | 144 (142–145) | 144 (143–145) | 144 (143–145) | 144 (143–145) | 144 (143–145) | 144 (143–145) | 144 (143–145) | 144 (143–145) | 144 (144–145) |
| Vaccination | 113 (64–121) | 90 (89–90) | 50 (50–51) | 113 (65–121) | 97 (89–121) | 50 (50–51) | 120 (120–121) | 90 (89–90) | 50 (50–51) |
| Cases averted | 31 (23–79) | 55 (54–55) | 94 (93–95) | 31 (23–79) | 47 (23–54) | 94 (93–95) | 24 (23–24) | 54 (54–55) | 94 (93–95) |
| Cost, US$ (per 1,000 people) | |||||||||
| No vaccination | 100,314‡ (82,167–123,169) | 102,578 (82,323–122,647) | 102,618 (82,310–122,938) | 100,322 (82,070–122,924) | 102,660 (82,043–123,221) | 102,637 (82,216–123,160) | 102,700 (82,424–123,143) | 102,556 (82,090–122,970) | 102,622 (82,281–123,159) |
| Vaccination | 86,016 (66,052–107,714) | 78,560 (63,883–93,149) | 64,018 (52,207–75,680) | 111,053 (90,979–132,887) | 106,091 (88,931–118,147) | 89,021 (77,367–100,674) | 185,818 (168,704–203,076) | 173,590 (159,215–188,287) | 158,987 (147,382–170,647) |
| Cost averted | 14,298 (8,292–33,813) | 24,018 (17,996–29,655) | 38,600 (29,766–47,555) | −10,731 (−16,925–9,030) | −3,430 (−16,073–5,114) | 13,616 (4,576–22,758) | −83,117 (−86,422–−79,659) | −71,034 (−77,246–−65,107) | −56,365 (−47,447–−65,206) |
| DALYs (per 1,000 people) | |||||||||
| No vaccination | 8,013 (7,873–8,152) | 8,012 (7,868–8,160) | 8,018 (7,870–8,174) | 8,016 (7,885–8,175) | 8,023 (7,866–8,163) | 8,025 (7,881–8,160) | 8,036 (7,915–8,173) | 8,028 (7,895–8,172) | 8,032 (7,902–8,157) |
| Vaccination | 7,876 (7,602–8,043) | 7,763 (7,673–7,871) | 7,578 (7,520–7,637) | 7,878 (7,624–8,027) | 7,802 (7,719–7,931) | 7,574 (7,510–7,617) | 7,922 (7,799–8,061) | 7,768 (7,678–7,852) | 7,578 (7,526–7,632) |
| DALYs averted | 137 (53–407) | 249 (166–329) | 440 (306–555) | 138 (48–394) | 221 (87–350) | 450 (337–548) | 114 (84–135) | 260 (197–329) | 454 (372–537) |
| ICER | Vaccine§ | Vaccine | Vaccine | 156 (61–384) | 9 (Vaccine-45) | Vaccine | 748 (603–1,038) | 285 (198–392) | 129 (88–175) |
*
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.
VL = visceral leishmaniasis; PKDL = post kala-azar dermal leishmaniasis; DALYs = disability adjusted life years; ICER = incremental cost-effectiveness ratio.