A Cost-Benefit Analysis of Programmatic Use of CVD 103-HgR Live Oral Cholera Vaccine in a High-Risk Population

Int J Epidemiol. 1997 Feb;26(1):212-9. doi: 10.1093/ije/26.1.212.

Abstract

Background: Cholera spread to Latin America in 1991; subsequently, cholera vaccination was considered as an interim intervention until long-term solutions involving improved water supplies and sanitation could be introduced. Three successive summer cholera outbreaks in northern Argentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this new vaccine.

Methods: This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the costs of vaccination with CVD 103-HgR in the relatively confined population of northern Argentina affected by the cholera outbreaks. Water supplies and sanitation in this area are poor but a credible infrastructure for vaccine delivery exists.

Results: In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-patients per 1000 population and assumptions of vaccine efficacy of 75% and coverage of 75%, vaccination of targeted high risk groups would prevent 1265 cases.

Conclusion: Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132,100. The projected savings would be altered less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than by disease incidence changes. Our analysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; Indirect losses to trade and tourism had the greatest economic impact. However, vaccination with CVD 103-HgR was still cost-beneficial in the base case.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Argentina / epidemiology
  • Child
  • Child, Preschool
  • Cholera / economics
  • Cholera / epidemiology*
  • Cholera / immunology
  • Cholera Vaccines / administration & dosage*
  • Cholera Vaccines / immunology
  • Cost-Benefit Analysis
  • Disease Outbreaks / economics*
  • Disease Outbreaks / prevention & control*
  • Female
  • Humans
  • Male
  • Vaccination / economics*
  • Vaccines, Attenuated / administration & dosage
  • Vaccines, Attenuated / immunology

Substances

  • Cholera Vaccines
  • Vaccines, Attenuated