$145-$446 (28). $83-$249 (16). $155-$477 (31). Table 2: Estimated procurement costs ... respectively. â« Figure 2 shows the cost of annual routine vaccination for.
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International Vaccine Access Center at Johns Hopkins University 415 N Washington St. • Baltimore, MD 21231 www.jhsph.edu/ivac • Twitter: @IVACtweets
Cost of Dengue Vaccine Introduction in Latin America and the Caribbean de Broucker a. International
a G ,
Martin del Campo
a J ,
Constenla
a,b D
Vaccine Access Center (IVAC) at Johns Hopkins University, Baltimore, MD U.S.A. b. Dengue Vaccine Initiative (DVI)
Results We modelled the financial impact of introducing a new vaccine in two costs: The initial rollout costs for each relevant age group for catch-up campaigns – the very high rollout cost every country face initially, spread over a 3-5 years introduction campaign. This cost accounts for the ‘lumpy’ nature of vaccine introduction costs and for each country’s choice of vaccination strategy. The annual cost of routine immunization follows the initial rollout cost as the lower, long-term maintenance cost of vaccinating newborns each year as part of the routine immunization schedule.
Introduction • Strategic planning for vaccine introduction requires credible information about the cost to achieve the objectives of the vaccine program, estimate the available funding, allocate funds within the program and avoid funding shortfalls. An analysis of the vaccine program costs is a key step in the planning process. • Cost estimates for the introduction of dengue vaccines are defined through Strategic Demand Forecasting (SDF). • SDF aids in overall strategic planning for vaccine introduction by allowing stakeholders to consider a variety of introduction scenarios. • Knowing how much an immunization program will cost allows donors or funding partners to develop financing strategies prior to licensure, consequently reducing barriers to early access. • We adopted an existing SDF model to estimate the cost of dengue vaccination in selected countries of the region based on disease burden, algorithms indicating capacity for introduction (Figure 1).
Methods • We include the full cost of vaccine implementation (e.g. cost of vaccine purchase, cost of vaccine delivery) for each country (Table 1). • Individual country data on birth rates, immunization coverage, and costs of vaccine delivery were used to estimate the cost of dengue vaccine introduction from the public health care perspective. • As the prices of dengue vaccines are not yet known, we varied the costs for Argentina, Brazil, Colombia, Ecuador, Mexico and Venezuela from $5-$15 per dose (sensitivity analysis in line with other new vaccines); the costs for Nicaragua, a GAVI-eligible country, was modelled a price at $0.20 per dose, the current contribution that GAVI seeks. • The campaign and routine costs were modelled using preliminary estimates of dengue implementation costs for upper-middle and high income countries1, and campaign and routine implementation costs for measles vaccine in low and lower-middle income countries2. • All costs were adjusted to 2014 USD.
Figure 1: Selected countries in Latin America & Caribbean
Age range Price per dose Time to achieve coverage Rollout costs
2 doses 10% Initial campaign: Ages 2-4: 90%; Ages 5-9: 80%; Ages 10-14: 70% Ongoing maintenance: Age 1: measles immunization coverage for dose 1; % change as for DTP1 to DTP3 Initial campaign: 2-14 year olds Ongoing maintenance: 1 year olds Public sector initial campaign price per dose: $5-15 for 2015-19; Gavi price per dose: $0.20 3 years for initial vaccine Sourced from literature: initial campaign and ongoing maintenance rollout costs modelled for low and lower-middle income countries, based on measles campaign costs2, and general rollout costs modelled for upper-middle and high income countries1, based on preliminary cost estimates for dengue campaign costs. For the latter countries, routine costs expected to be lower.
References 1. Shepard, D.S., & Suaya J.A. (2010). Cost-effectiveness of a dengue vaccine in Southeast Asia and Panama: preliminary estimates. Handbook of Disease Burdens and Quality of Life Measures, Part 22.5, 1281–1296. 2. Vijayaraghavan, M., Lievano, F., Cairns, L., Wolfson, L., Nandy, R., Ansari, A., Golaz, A., Mashal, T., & Salama, P. (2006). Economic Evaluation of Measles Catch-Up and Follow-Up Campaigns in Afghanistan in 2002 and 2003. Disasters, 30(2), 256-269.
Disclosure: This document was made possible with a sponsored grant from the International Vaccine Institute, a core partner of the Dengue Vaccine Initiative who received funding from Sanofi Pasteur.
Initial rollout costs
Table 2 shows the estimated vaccine purchase cost during the first 5 years of use in selected countries of the region (public sector), assuming $0.20 per dose for GAVI countries (Nicaragua) and $5 per dose for all the remaining countries. For the first five years of use for Brazil (urban only) we are projecting up to 254 million doses and up to 299 million doses (entire endemic area) at a vaccine purchase cost between $404-2,757 million and $477-3,233 million, respectively. Figure 2 shows the cost of annual routine vaccination for selected countries of the region. For the majority of the countries the total cost of rollout is less than $50 million each spread over three years. For Brazil the same campaign would cost over $1.5 billion spread over three years at a vaccine price of $15.
Figure 3 shows the cost per selected countries of an initial rollout campaign to 2-14 year olds in urban areas and the entire country. For the majority of the countries the total cost of rollout is less than $6 billion each spread over three years. For Brazil in urban areas the same campaign would cost under $2 billion spread over three years at a vaccine price of $15. Figure 4 shows the cost per selected countries of an initial rollout campaign to 15-45 year olds in urban areas and the entire country. For the majority of the countries the total cost of rollout is less than $500 million each spread over three years. For Brazil the same campaign would cost over $4.5 billion spread over three years at a vaccine price of $15.
Table 2: Estimated procurement costs for first five years of use (2014 USD)
Countries Argentina Brazil Colombia Ecuador Mexico Nicaragua Venezuela
Table 1: SDF model assumptions Dosage Wastage Coverage
Procurement costs
Urban only * (doses in million in parenthesis) 2-14 years old 15-45 years old $62-$197 (13) $135-$415 (27) $404-$1,202 (77) $922-$2,757 (177) $62-$187 (12) $124-$383 (24) $31-$83 (6) $52-$166 (11) $228-$684 (44) $415-$1,244 (80) $0.6-$41 (2) $1.2-$73 (4) $73-$228 (15) $145-$446 (28)
Entire endemic area* (doses in million in parenthesis) 2-14 years old 15-45 years old $73-$218 (14) $155-$456 (29) $477-$1,420 (91) $1,078-$3,233 (208) $83-$249 (16) $176-$518 (33) $42-$135 (9) $83-$259 (17) $301-$902 (58) $539-1,620 (105) $1-$62 (4) $2.2-$124 (8) $83-$249 (16) $155-$477 (31)
Figure 3: Costs of catch-up campaigns for 2-14 years old
Figure 4: Costs of catch-up campaigns for 15-45 years old
* Prices in million 2014 US$ undiscounted
Figure 2: Annual cost of routine immunization for dengue
Note: Costs are in millions of 2014 USD. Low and lower-middle income countries are indicated with * Legend: Urban population Entire population 0
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4
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8
10
0
12
20
40
60
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100
120
0
Bolivia*
Bolivia*
Bolivia*
Costa Rica
Costa Rica
Costa Rica
Dominican Republic*
Dominican Republic*
Dominican Republic*
El Salvador*
El Salvador*
El Salvador*
Honduras*
Honduras*
Honduras*
Nicaragua*
Nicaragua*
Nicaragua*
Panama
Panama
Panama
Paraguay
Paraguay
Paraguay
Puerto Rico
Puerto Rico
Puerto Rico
0
50
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0
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1000
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0
Brazil
Brazil
Brazil
Colombia
Colombia
Colombia
Ecuador
Ecuador
Ecuador
Mexico
Mexico
Mexico
Venezuela
Venezuela
Venezuela
50
100
2000
150
4000
Conclusions An initial rollout campaign among children aged 2-14 years that would extend coverage across the entire country is significantly more expensive. Smaller and less rural countries experienced less of an increase in costs. The impact of vaccine pricing is substantial. An analysis of the costing of vaccine program is a key step in the planning process. Introducing a new vaccine puts strain on scarce resources.
© International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health. 2014. All Rights Reserved.
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