Haemophilus influenzae type b vaccine in low- and middle- income countries:\ud Impact, costs and incremental cost-utility.

Doctoral thesis English OPEN
Griffiths, UK

Haemophilus influenzae type b (Hib) is an infectious bacterium transmitted from person to person through close contact. Hib can cause meningitis, pneumonia and a number of rarer forms of disease, primarily in children less than five years. Hib conjugate vaccines became available during the early 1990s and high-income countries quickly introduced this vaccine into their routine programmes and have now achieved a near disappearance of Hib disease. However, relatively high vaccine prices and uncertainties about Hib disease burden led to a slow uptake in low- and middle-income countries.\ud The aim of this PhD is to fill gaps in knowledge about the value of Hib vaccination, in terms of whether or not it is a cost-effective intervention in low- and middle-income countries. Moreover, since economic evaluation involves gathering evidence about numerous criteria that may be considered in isolation by policy makers, such as vaccine efficacy, disease burden, meningitis sequelae prevalence and cold chain expansion costs, specific objectives are also to address some of the unanswered questions about key inputs and determinants of cost-effectiveness.\ud The framework of the PhD is shaped around a decision-analytic model designed to estimate the cost-utility of Hib vaccination. The methodology, collection and analysis of data inputs needed to populate the model represent a number of sub-studies, which are all contributions to new evidence. These include a meta-analysis of Hib vaccine efficacy, calculation of Disability Adjusted Life Years due to Hib disease, estimation of treatment costs of Hib disease, assessment of productivity costs due to meningitis sequelae, and calculation of systems costs of introducing Hib vaccine. Case studies from two countries are included in the sub-studies; productivity costs of meningitis sequelae are investigated in Senegal and systems costs of Hib vaccine introduction are estimated in Ethiopia. Cost-utility results generated from the decision-analytic model are presented for two low-income countries; India and Uzbekistan, and one middle-income country; Belarus.\ud This PhD thesis is the first attempt to combine evidence on disease burden, costs and impact of Hib vaccine across multiple countries using a consistent framework and comparable input parameters. As a result, new insights into the relative cost-utility in countries with different economic and epidemiological circumstances are obtained.
  • References (40)
    40 references, page 1 of 4

    1. Griffiths UK, Korczak V, Ayalew D, Yigzaw A, Incremental system costs of introducing combined DTwP-Hepatitis B-Hib vaccine into National Immunization Services in Ethiopia, Vaccine. 2009 Feb 25; 27(9)

    2. Griffiths UK, Miners A, Cost-effectiveness of Haemophilus influenza type b vaccine: A systematic review of the literature, Expert Review of Pharmacoeconomics and Outcome Research, 2009 August (4):333-46

    3. Griffiths UK, Clark A, Shimanovich V, Glinskaya I, Tursonova,Kim L, Mosina L, Hajjeh, R, Edmond K, Comparative economic evaluation of Haemophilus influenzae type b vaccine in Belarus and Uzbekistan, PLoS One. 2011;6(6)

    4. Griffiths UK, Clark A , Gessner B, Miners A, Sanderson C, Sedyaningsih ER, Mulholland K, Efficacy of Haemophilus influenzae type b conjugate vaccines: Systematic review and meta-analysis, Epidemiol Infect. 2012 May 14:1-13. [Epub ahead of print]

    5. Griffiths UK, Dieye, Y, Fleming J, Hajjeh, R, Edmond K, Costs of meningitis sequelae in Dakar, Senegal, Pediatr Infect Dis J. 2012 Jun 4. [Epub ahead of print]

    1. Ayieko P, Akumu AO, Griffiths UK, English M., The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis, Cost Eff Resour Alloc. 2009 Jan 22;7:3.

    2. Edmond K, Clark A, Korczak V, Sanderson C, Griffiths UK, Rudan I. Global and regional risks of disabling sequelae from bacterial meningitis. Lancet Infect Dis. 2010 May;10(5):317-28.

    3. Edmond K, Dieye Y, Griffiths UK, Fleming J, Ba O, Diallo N, Mulholland K, Prospective Cohort Study of Disabling Sequelae and Quality of Life in Children With Bacterial Meningitis in Urban Senegal, Pediatr Infect Dis J. 2010 Nov;29(11):1023-9

    4. Ojo LR, O'Loughlin RE, Cohen AL, Edmond KM, Shetty SS, Bear AP, Loo JD, Privor-Dumm L, Griffiths UK, Zuber PLF, Mayers GF,Hajjeh RA, Global Use of Haemophilus influenzae type b conjugate vaccine, Vaccine. 2010 Oct 8;28(43):7117-22

    5. Hajjeh RA, Privor-Dumm L, Edmond K, O'Loughlin R, Shetty S, Griffiths UK, Bear AP, Cohen AL, Chandran A, Schuchat A, Mulholland EK, Santosham M, Supporting new vaccine introduction decisions: lessons learned from the Hib Initiative experience. Vaccine. 2010 Oct 8;28(43):7123-9.

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