The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: a disease modeling and economic analysis

Ashraful Islam Khan, Ann Levin, Dennis L. Chao, Denise DeRoeck, Dobromir T. Dimitrov, Jahangir A. M. Khan, Muhammad Shariful Islam, Mohammad Ali, Md. Taufiqul Islam, Abdur Razzaque Sarker, John D. Clemens, Firdausi Qadri

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations.

METHODOLOGY/PRINCIPAL FINDINGS: Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group.

CONCLUSIONS/SIGNIFICANCE: Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.

LanguageEnglish
Article numbere0006652
Number of pages22
JournalPLOS Neglected Tropical Diseases
Volume12
Issue number10
DOIs
Publication statusPublished - 9 Oct 2018

Fingerprint

Cholera Vaccines
Bangladesh
Cholera
Cost-Benefit Analysis
Economics
Vaccination
Poverty Areas
Quality-Adjusted Life Years
Costs and Cost Analysis
Population
Incidence
Immunization Programs
Cost Savings
Health Care Costs
Vaccines
Public Health
Age Groups

Keywords

  • cholera
  • Bangladesh
  • disease control
  • cost-effectiveness
  • preventive vaccination

Cite this

Khan, Ashraful Islam ; Levin, Ann ; Chao, Dennis L. ; DeRoeck, Denise ; Dimitrov, Dobromir T. ; Khan, Jahangir A. M. ; Islam, Muhammad Shariful ; Ali, Mohammad ; Islam, Md. Taufiqul ; Sarker, Abdur Razzaque ; Clemens, John D. ; Qadri, Firdausi. / The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh : a disease modeling and economic analysis. In: PLOS Neglected Tropical Diseases. 2018 ; Vol. 12, No. 10.
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abstract = "BACKGROUND: Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations.METHODOLOGY/PRINCIPAL FINDINGS: Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45{\%} (assuming 10{\%} annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90{\%}, but would be 50{\%} less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7{\%} of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group.CONCLUSIONS/SIGNIFICANCE: Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.",
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The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh : a disease modeling and economic analysis. / Khan, Ashraful Islam; Levin, Ann; Chao, Dennis L.; DeRoeck, Denise; Dimitrov, Dobromir T.; Khan, Jahangir A. M.; Islam, Muhammad Shariful; Ali, Mohammad; Islam, Md. Taufiqul; Sarker, Abdur Razzaque; Clemens, John D.; Qadri, Firdausi.

In: PLOS Neglected Tropical Diseases, Vol. 12, No. 10, e0006652, 09.10.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh

T2 - PLOS Neglected Tropical Diseases

AU - Khan, Ashraful Islam

AU - Levin, Ann

AU - Chao, Dennis L.

AU - DeRoeck, Denise

AU - Dimitrov, Dobromir T.

AU - Khan, Jahangir A. M.

AU - Islam, Muhammad Shariful

AU - Ali, Mohammad

AU - Islam, Md. Taufiqul

AU - Sarker, Abdur Razzaque

AU - Clemens, John D.

AU - Qadri, Firdausi

PY - 2018/10/9

Y1 - 2018/10/9

N2 - BACKGROUND: Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations.METHODOLOGY/PRINCIPAL FINDINGS: Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group.CONCLUSIONS/SIGNIFICANCE: Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.

AB - BACKGROUND: Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations.METHODOLOGY/PRINCIPAL FINDINGS: Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group.CONCLUSIONS/SIGNIFICANCE: Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.

KW - cholera

KW - Bangladesh

KW - disease control

KW - cost-effectiveness

KW - preventive vaccination

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