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Measles vaccination of young infants in China: A cost-effectiveness analysis.

Abstract：

BACKGROUND:Although global progress in measles control has been realized, achieving elimination has proven difficult in many regions of the world. China has adopted a goal of measles elimination but recent outbreaks predominantly affecting children <8 months who are ineligible for vaccination and incompletely protected by maternal antibodies has impeded progress. We assess the cost-effectiveness of adding an initial measles vaccine dose in China to earlier than the currently recommended 8 months of age. METHODS:We conducted a cost-utility analysis comparing the costs and health benefits associated with adding a measles vaccine dose to the routine schedule at 4, 5, 6 or 7 months compared to the current recommendation for the first dose at age 8 months. A decision analytic model was developed in Microsoft Excel, including five non-severe and two fatal health outcomes associated with measles infection. Model parameters were informed by the literature and surveillance data. Future costs and health benefits were discounted at 3%. Primary outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime time horizon. RESULTS:Lowering the recommended age for initiating the measles vaccination series to address susceptibility in children <8 months provided incremental health gains compared to minimal costs at the individual-level. The ICER was most favorable ($232.70 per QALY gain) for administering an initial dose at 4 months of age due to fewer incremental program costs when shifting measles administration to an immunization visit already established under the Chinese vaccination program. CONCLUSION:We found potential beneficial health gains at a minimum cost associated with adding an earlier measles dose <8 months of age in China. Further investigation about disease transmission dynamics is required to more fully assess the tradeoffs of administering measles at a younger age to infants in China.

journal_name

Vaccine

journal_title

Vaccine

authors

Janusz CB,Wagner AL,Masters NB,Ding Y,Zhang Y,Hutton DW,Boulton ML

doi

10.1016/j.vaccine.2020.04.079

subject

Has Abstract

pub_date

2020-06-15 00:00:00

pages

4616-4624

issue

29

eissn

0264-410X

issn

1873-2518

pii

S0264-410X(20)30607-1

journal_volume

38

pub_type

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