Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya

by John Ojal, PhD; Ulla Griffiths, PhD; Laura L Hammitt, MD; Ifedayo Adetifa, PhD; Donald Akech, BSc; Collins Tabu, PhD; et al.

To be published in The Lancet Global Health, May 2019. 



In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, researchers assessed the incremental cost-effectiveness of continuing PCV use.


In this modelling and cost-effectiveness study, the study team fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. The study team predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. The costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI) were calculated.


Researchers predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100,000 in 2022, to 16·2 per 100,000 per year in 2032. Continuing vaccination would prevent 14,329 deaths and 101,513 disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. Researchers also predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70–411) in 2032.


Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya.



Article access can be found here




Also read the associated editorial, "Are expensive vaccines the best investment in low-income and middle-income countries?" by authors Lone Simonsen, Maarten van Wijhe, and Robert Taylor:


"In a new study in The Lancet Global Health, John Ojal and colleagues project that the use of ten-valent pneumococcal conjugate vaccine (PCV10) will be cost-effective in Kenya after international donor support for vaccine programmes ends in around 2027. Until now, Kenya has relied on funding from Gavi, the international vaccine alliance, to fund its PCV programme. But because Gavi withdraws support from countries as their economies grow, Kenya will have to bear the full $9 per child cost for a three-dose course of PCVs starting in 2027. For Kenya, where annual per capita actual expenditure for health is around $70 (about 5% of GDP), that is not a trivial cost. ..."



Access the editorial here.





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Wednesday, 26 February 2020