Table 2.
Clinical outcomes [mean (95% uncertainty interval)] and total costs (net present value; $US in millions) among 10,000 Chagas-infected pregnant women at current transmission risk estimates (distribution with a median of 5%, range 4% to 6%) for various vaccination strategies
| Number of Congenital Cases | Number of Infant Deaths | Number of Infants that Can Progress to Chronic Disease | Disability-Adjusted Life Years | Total Cost* |
Incremental Cost-Effectiveness Ratio (ICER)^ |
|||
|---|---|---|---|---|---|---|---|---|
| Third-Party Payer Perspective | Societal Perspective | Third-Party Payer Perspective | Societal Perspective | |||||
| No vaccination | 500 (405–600) | 8 (0–20) | 229 (145–330) | 313.8 (0.7–750.9) $50 vaccination |
1.0 (0.7–1.2) | 3.8 (0.9–11.4) | - | - |
| 25% efficacy | 375 (290–460) | 6 (0–20) | 172 (100–250) | 235.7 (0.5–600.8) | 1.3 (1.1–1.6) | 3.4 (1.3–6.8) | 4,648 | Dominant |
| 50% efficacy | 249 (185–320) | 4(0–15) | 115 (60–190) | 154.0 (0.2–450.4) | 1.2 (1.0–1.4) | 2.6 (1.1–5.4) | 1,438 | Dominant |
| 75% efficacy | 125 (80–170) | 2 (0–10) | 57 (20–110) | 75.7 (0.1–300.2) $100 vaccination |
1.0 (.9–1.2) | 1.8 (1.0–3.8) | 357 | Dominant |
| 25% efficacy | 374 (290–460) | 6 (0–20) | 172 (100–255) | 221.4 (0.5–600.6) | 1.8 (1.6–2.1) | 4.0 (1.8–7.4) | 11,175 | 2,071 |
| 50% efficacy | 250 (180–320) | 4(0–15) | 115 (60–190) | 153.8 (0.2–450.5) | 1.7 (1.5–1.9) | 3.1 (1.6–5.8) | 4,622 | Dominant |
| 75% efficacy | 126 (80–175) | 2 (0–10) | 58 (20–110) | 78.1 (0.1–300.2) $200 vaccination |
1.5 (1.4–1.7) | 2.3 (1.5–4.3) | 2,556 | Dominant |
| 25% efficacy | 376 (295–460) | 6 (0–20) | 173 (100–255) | 231.1 (0.5–600.6) | 2.8 (2.6–3.1) | 5.0 (2.8–8.4) | 24,341 | 13,859 |
| 50% efficacy | 249 (185–320) | 4(0–15) | 115 (55–190) | 151.3 (0.3–450.4) | 2.7 (2.5–2.9) | 4.1 (2.6–6.9) | 10,988 | 1,945 |
| 75% efficacy | 125 (75–175) | 2 (0–10) | 57 (20–115) | 74.5 (0.1–300.2) $500 vaccination |
2.5 (2.4–2.7) | 3.3 (2.5–5.4) | 6,981 | Dominant |
| 25% efficacy | 373 (320–550) | 6 (0–50) | 172 (100–255) | 228.6 (0.7–1,500.0) | 5.8 (5.6–6.1) | 8.0 (2.9–13.3) | 63,528 | 51,900 |
| 50% efficacy | 250 (205–460) | 4(0–25) | 115 (60–190) | 150.3 (0.4–900.0) | 5.7 (5.5–5.9) | 7.1 (2.7–10.5) | 29,040 | 20,811 |
| 75% efficacy | 125 (95–205) | 2 (0–20) | 58 (20–115) | 79.6 (0.1–600.0) | 5.5 (5.4–5.7) | 6.3 (2.5–9.2) | 19,352 | 10,742 |
*
In millions of $US; Cost includes only those incurred during infancy and excludes lifetime costs associated with chronic Chagas disease.
^
ICER is cost per disability adjusted life year averted; ICERs ≤$9,989/DALY averted are considered highly cost-effective, ICERs between $9,990–29,697/DALY averted are considered cost-effective, ICERs >$29,697/DALY averted are considered not cost-effective; dominant = less costly and provides health benefits.