Cost-effectiveness of providing measles vaccination to all children in Guinea-Bissau

Figures & data

Table 1. Model parameters.

Variable used	Value	Source of information [reference]
2011 birth cohort (number of children)	59,062	[14]
Percentage of the 2011 birth cohort under surveillance by BHP who died before 9 months of age	7.6%	BHP surveillance data
2011 birth cohort surviving until 9 months of age (number of children)	54,573
Hospital admission rate among children aged 9–48 months per 1000 person years (restrictive MV clusters)	12.5	BHP routine surveillance data
Hospital admission rate among children aged 9–48 months per 1000 person years (MV-for-all clusters)	8.9	BHP routine surveillance data
Mean duration of hospital admission (days)	7.6	BHP routine surveillance data
Cost per hospital bed-day (USD)	14.97	[18]
MV-associated mortality reduction	46%	[12]
Household costs of accompanying a child to hospital per day (USD)	2.8	[19]
Life expectancy in Guinea-Bissau (years)	55	[20]
Infant mortality rate (not including neonates) in Guinea-Bissau	47.6/1000	[21]
Mortality rate 1–4 years in Guinea-Bissau	71.2/1000 (17.8 per year)	[21]

Table 2. Measles vaccine-related costs under the restrictive MV policy and the MV-for-all policy.

	Restrictive MV policy	MV-for-all policy
Vaccine wastage (Vaccine wastage factor [VWF])	40% (VWF = 1.67)	90% (VWF = 10)
MV coverage	84%	97%
MV vial costs (USD)	22,676	157,113
Injection supply costs (USD)	2820	5464
Total vaccine costs (USD)	25,497	162,578
Extra household costs of seeking MV (USD)	28,924
Total costs of the policy (USD)	54,420	162,578
Costs per child vaccinated (USD)	1.19	3.08
Cost-savings due to hospital admissions averted (USD)		84,475

Table 3. Years of life gained by age of measles vaccination.

Age group	Children alive in the 2011 birth cohort	Mortality rate (per 1000 live born)	Coverage (restrictive MV clusters)	Coverage (MV-for-all clusters)	Deaths averted*	Life years gained	Discounted life years gained
9–12 months	54,573	0.0130	67%	75%	26	1480	697
12–23 months	53,891	0.0178	67%	75%	35	1871	937
24–35 months	52,967	0.0178	83%	93%	43	2255	1142
36–48 months	52,067	0.0178	84%	97%	56	2827	1447
Total			84%	97%	160	8361	4223

Note: *Calculation for deaths averted: number of children*mortality rate*0.46*coverage difference.

Table 4. Cost-effectiveness results.

	Costs (USD)	Incremental effects	Incremental cost-effectiveness
Restrictive MV policy	54,420	0	0
MV-for-all policy	78,102	4223 discounted LYG	5.61 USD/LYG
MV-for-all policy	78,102	160 deaths averted	148 USD/death averted

Note: LYG – life years gained.

Table 5. Sensitivity analyses.

	Costs (USD)	Incremental effects	Incremental cost-effectiveness
80% MV wastage
Restrictive MV policy	54,420	0	Reference
MV-for-all policy	−1779	4223 discounted LYG	Cost-saving
MV-for-all policy	−1779	160 deaths averted	Cost-saving
70% MV wastage
Restrictive MV policy	54,420	0	Reference
MV-for-all policy	−28,406	4223 discounted LYG	Cost-saving
MV-for-all policy	−28,406	160 deaths averted	Cost-saving
33% reduction in mortality due to MV as obtained from trial [11]
Restrictive MV policy	54,420	0	Reference
MV-for-all policy	78,102	3029 discounted LYG	7.8 USD/LYG
MV-for-all policy	78,102	115 deaths averted	206 USD/death averted
Lower confidence interval boundary from WHO review (35%) [12]
Restrictive MV policy	54,420	0	Reference
MV-for-all policy	78,102	3212 discounted LYG	7.4 USD/LYG
MV-for-all policy	78,102	122 deaths averted	194 USD/death averted
Upper confidence interval boundary from WHO review (55%) [12]
Restrictive MV policy	43,506	0	Reference
MV-for-all policy	78,102	5050 discounted LYG	4.7 USD/LYG
MV-for-all policy	78,102	192 deaths averted	124 USD/death averted
Using only costs incurred by the health system
Restrictive MV policy	25,497	0	Reference
MV-for-all policy	91,413	4223 discounted LYG	15.6 USD/LYG
MV-for-all policy	91,413	160 deaths averted	412 USD/death averted

Note: LYG – life years gained.

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