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Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.

Abstract：

INTRODUCTION:One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. METHODS:We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. RESULTS:Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. DISCUSSION:Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.

journal_name

Vaccine

journal_title

Vaccine

authors

Doshi RH,Eckhoff P,Cheng A,Hoff NA,Mukadi P,Shidi C,Gerber S,Wemakoy EO,Muyembe-Tafum JJ,Kominski GF,Rimoin AW

doi

10.1016/j.vaccine.2017.09.038

subject

Has Abstract

pub_date

2017-10-27 00:00:00

pages

6187-6194

issue

eissn

0264-410X

issn

1873-2518

pii

S0264-410X(17)31267-7

journal_volume

pub_type

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Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.