Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for infants in Peru: a cost-consequence analysis of vaccination coverage.

Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for infants in Peru: a cost-consequence analysis of vaccination coverage.

Publication date: Oct 10, 2024

Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru’s infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months). The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses. The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8. 1%), $59,121,545 (+ 4. 2%) and $64,872,734 (+ 14. 4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3. 1% points with expanded delivery alone, and by 9. 4 and 14. 3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5. 7% and 8. 7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis. Implementation of the hexavalent vaccine in Peru’s National Immunization Program has a positive public health cost consequence.

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Concepts Keywords
Exacerbated Cost-consequence analysis
Hepatitis Diphtheria-tetanus-pertussis
Peru Hepatitis B
Vaccination Hexavalent vaccination
Polio
Vaccination coverage gap
Vaccination coverage rate

Semantics

Type Source Name
disease MESH pertussis
pathway KEGG Pertussis
disease MESH COVID-19 pandemic
disease MESH diphtheria
disease MESH tetanus
disease MESH polio
disease MESH hepatitis B
pathway KEGG Hepatitis B
disease IDO cell
disease MESH vaccine-preventable diseases
pathway REACTOME Reproduction
disease MESH hepatitis
disease MESH community transmission
disease IDO virulence
disease MESH paralysis
disease IDO process
disease IDO country
drug DRUGBANK Trestolone
drug DRUGBANK Ilex paraguariensis leaf
disease IDO intervention
disease IDO history
drug DRUGBANK Aspartame
drug DRUGBANK Coenzyme M
disease IDO susceptibility
disease MESH infection
disease IDO infected population
drug DRUGBANK Hexadecanal
disease IDO facility
drug DRUGBANK Etoperidone
disease MESH myelitis
disease MESH allergic reactions
drug DRUGBANK Gold
disease MESH recurrence
drug DRUGBANK Pheniramine

Original Article

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