Table 5.
Cost-effectiveness of standalone vaccines for ETEC and Shigella, when limited to settings with an ICER less than three times the GDP threshold, by region, 2025–2034. Results from uncertainty analysis are listed below model estimates. Upper and Lower represent 95% uncertainty intervals for each estimate.
| AFRO | AMRO | EMRO | SEARO | WPRO** | GAVI-eligible | Global | |
|---|---|---|---|---|---|---|---|
| ETEC vaccination | |||||||
| Number of countries ICER < 3 X GDP | 17 | 3 | 4 | – | 3 | 19 | 27 |
| [7; 21] | [1; 4] | [2; 5] | – | [ND; 3] | [6; 24] | [10; 34] | |
| Total deaths* averted (1000 s) | 45.6 | 1.0 | 13.6 | – | 0.4 | 35.0 | 60.7 |
| [23.6; 71.3] | [0.2; 1.5] | [2.7; 19.4] | – | [ND; 0.6] | [10.0; 59.3] | [26.8; 116.1] | |
| Total deaths* averted/100,000 FVC*** | 7.2 | 2.5 | 4.6 | – | 2.2 | 5.4 | 6.1 |
| [5.5; 9.9] | [1.2; 3.7] | [2.8; 6.2] | – | [ND; 3.0] | [4.1; 7.6] | [3.9; 8.0] | |
| Total DALYs* averted (1000 s) | 1,561 | 35 | 464 | – | 13 | 1,194 | 2,073 |
| [807; 2,440] | [8; 51] | [93; 659] | – | [ND; 19] | [341; 2,026] | [915; 3,970] | |
| Total DALYs* averted/100,000 FVC*** | 246 | 86 | 155 | – | 76 | 185 | 209 |
| [190; 340] | [40; 128] | [94; 211] | – | [ND; 100] | [140; 260] | [133; 273] | |
| Vaccination costs (millions US$) | 2,259 | 146 | 1,055 | – | 60 | 2,295 | 3,520 |
| [1,550; 2,944] | [69; 183] | [332; 1,631] | – | [ND; 95] | [821; 3,026] | [2,333; 7,928] | |
| Vaccination costs/100,000 FVC*** | 355,702 | 356,373 | 353,238 | – | 352,397 | 356,570 | 354,931 |
| [274,110; 561,392] | [265,267; 557,867] | [253,764; 557,408] | – | [ND; 546,333] | [274,842; 563,324] | [272,039; 561,229] | |
| Administration costs/100,000 FVC*** | 98,453 | 99,057 | 96,233 | – | 95,475 | 99,234 | 97,757 |
| [65,886; 125,759] | [63,968; 126,238] | [60,760; 123,783] | – | [ND; 122,304] | [66,462; 127,364] | [65,076; 124,893] | |
| Medical costs averted (millions US$) | 82 | 10 | 43 | – | 2 | 80 | 137 |
| [34; 127] | [3; 17] | [7; 62] | – | [ND; 4] | [13; 125] | [49; 374] | |
| ICER (2016 US$/DALY) | 1,395 | 3,871 | 2,181 | – | 4,474 | 1,856 | 1,632 |
| [982; 2,154] | [2,479; 9,664] | [1,203; 3,681] | – | [ND; 6,655] | [1,206; 2,762] | [1,449; 2,530] | |
| Shigella vaccination | |||||||
| Number of countries ICER < 3 X GDP | 18 | 3 | 8 | – | – | 22 | 29 |
| [8; 23] | [1; 4] | [5; 8] | – | – | [10; 27] | [14; 37] | |
| Total deaths* averted (1000 s) | 52.7 | 1.1 | 53.0 | – | – | 76.5 | 106.8 |
| [27.1; 91.0] | [0.2; 1.6] | [31.9; 71.9] | – | – | [41.1; 121.4] | [59.4; 188.3] | |
| Total deaths* averted/100,000 FVC*** | 7.9 | 2.6 | 10.7 | – | – | 10.1 | 8.8 |
| [6.1; 10.9] | [1.2; 3.9] | [8.1; 15.2] | – | – | [8.2; 14.2] | [5.3; 11.9] | |
| Total DALYs* averted (1000 s) | 1,746 | 36 | 1,777 | – | – | 2,556 | 3,559 |
| [901; 3,010] | [8; 53] | [1,070; 2,412] | – | – | [1,377; 4,041] | [1,983; 6,255] | |
| Total DALYs* averted/100,000 FVC*** | 260 | 89 | 357 | – | – | 339 | 294 |
| [202; 361] | [41; 130] | [270; 508] | – | – | [273; 476] | [176; 395] | |
| Vaccination costs (millions US$) | 2,386 | 146 | 1,763 | – | – | 2,693 | 4,296 |
| [1,650; 3,237] | [71; 187] | [1,250; 2,426] | – | – | [1,811; 3,597] | [3,030; 9,202] | |
| Vaccination costs/100,000 FVC*** | 355,503 | 356,373 | 354,360 | – | – | 356,897 | 355,062 |
| [275,835; 560,639] | [268,790; 558,302] | [272,641; 560,870] | – | – | [276,720; 562,627] | [273,263; 560,780] | |
| Administration costs/100,000 FVC*** | 98,273 | 99,057 | 97,243 | – | – | 99,529 | 97,876 |
| [66,166; 125,794] | [64,733; 125,497] | [65,110; 124,785] | – | – | [67,012; 127,662] | [65,318; 124,896] | |
| Medical costs averted (millions US$) | 98 | 10 | 213 | – | – | 184 | 321 |
| [38; 151] | [3; 17] | [74; 302] | – | – | [81; 269] | [116; 652] | |
| ICER (2016 US$/DALY) | 1,311 | 3,750 | 872 | – | – | 981 | 1,117 |
| [899; 1,960] | [2,465; 9,416] | [539; 1,260] | – | – | [713; 1,366] | [1,045; 1,687] | |
*
Total deaths and DALYS are the sum of burden attributed to diarrhea from ETEC or Shigella infection and ETEC- or Shigella-induced deaths from other infectious diseases.
**
“ND” indicates ‘not defined’ as there were no WPRO countries that met the threshold under the predicted lower bounds (2.5%) of the 95% uncertainty intervals.
***
Fully vaccinated children (FVC): Number of eligible children who received all three doses of the vaccine.