International Journal of Epidemiology, Vol 26, 212-219, Copyright © 1997 by International Epidemiological Association
ST Cookson, D Stamboulian, J Demonte, L Quero, C Martinez de Arquiza, A Aleman, A Lepetic and MM Levine
BACKGROUND: Cholera spread to Latin America in 1991; subsequently, cholera
vaccination was considered as an interim intervention until long-term
solutions involving improved water supplies and sanitation could be
introduced. Three successive summer cholera outbreaks in northern Argentina
and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR,
raised questions of the cost and benefit of using this new vaccine.
METHODS: This study explored the potential benefits to the Argentine
Ministry of Health of treatment costs averted, versus the costs of
vaccination with CVD 103-HgR in the relatively confined population of
northern Argentina affected by the cholera outbreaks. Water supplies and
sanitation in this area are poor but a credible infrastructure for vaccine
delivery exists. RESULTS: In our cost-benefit model of a 3-year period
(1992-1994) with an annual incidence of 2.5 case-patients per 1000
population and assumptions of vaccine efficacy of 75% and coverage of 75%,
vaccination of targeted high risk groups would prevent 1265 cases.
CONCLUSION: Assuming a cost of US$602 per treated case and of US$1.50 per
dose of vaccine, the total discounted savings from use of vaccine in the
targeted groups would be US$132,100. The projected savings would be altered
less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than
by disease incidence changes. Our analysis underestimated the true costs of
cholera in Argentina because we included only medical expenditures;
Indirect losses to trade and tourism had the greatest economic impact.
However, vaccination with CVD 103-HgR was still cost-beneficial in the base
case.
ARTICLES
A cost-benefit analysis of programmatic use of CVD 103-HgR live oral cholera vaccine in a high-risk population
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore 21201, USA.
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