Economic impact of switching from partially combined vaccine “Pentaxim® and hepatitis B” to fully combined vaccine “Hexaxim®” in the Malaysian National Immunization Program

Background The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents’/caregivers’ perceptions. Methods In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents’/caregivers’ questionnaire. Also, HCPs’ and parent’s/caregivers’ perceptions were investigated using structured questionnaires. Results The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects. Conclusions Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B. Trial registration Not applicable.

Estimating the impact of implementation and timing of COVID-19 vaccination program in Brazil: a counterfactual analysis

The vaccines developed in 2020-2021 against the SARS-CoV-2 virus were designed to prevent severity and deaths due to COVID-19. However, how effective this vaccination campaign was at saving lives remains a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalizations in individuals above 60 years old in Brazil. Using the actual number of hospitalized and deaths from the Brazilian database, and also the coverage of second dose according to the National Immunization Program, we rebuilt the realized scenario as well as the hypothetical scenario without vaccination in Brazil in order to perform a counterfactual analysis. By computing the difference between the hypothetical and realized scenarios, we were able to estimate the direct effect of COVID-19 vaccination in Brazil. We also evaluated two other hypothetical, but not impossible, scenarios considering earlier vaccination roll-outs. We estimated that more than 165 thousand of 60+ years old individuals were not hospitalized due to COVID-19 until August 28, 2021, and other approximately 100 thousand individuals could not have been hospitalized if the immunization started as soon it was approved in Brazil. We also estimate that more than 75 thousand lives were saved in the period analysed for the same age group, and additional 48 thousand lives could have been saved if the Brazilian Government started the immunization 8 weeks earlier.

Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.

Incomplete vaccination for conjugated meningococcal C and hepatitis B at municipal, state and federal level: 2015 a 2019

Brazil has the National Immunization Program for disease prevention that offers nineteen vaccines, yet it is known that vaccination coverage according to age is not always reached. Thus, this study aimed to evaluate the vaccination coverage in the municipality of Sinop, in the Mato Grosso state and in the Brazil for meningococcal C conjugate vaccines and Hepatitis B in the period from 2015 to 2019. Method: This is a descriptive, retrospective and cross-sectional study, with data available in the Information System of the National Immunization Program. Results: Vaccination coverage for mingococcal C in children under one year in Sinop was above the target in 2015 and 2018, Mato Grosso was above only in 2015, for the booster dose only Sinop was above the target in 2016. Coverage for hepatitis B in children under 30 days of life demonstrated that Sinop had coverage above the state of Mato Grosso, which in turn was above Brazil. For children under 1 year old, only in 2016 and 2019 the state presented greater vaccination coverage at the expense of Sinop and Brazil. Conclusion: The results demonstrate that there is hesitation on the part of the population regarding vaccination, being greater in vaccines such as meningococcal C. Strengthening childcare is the key to improving the panorama of vaccine coverage.

Carriage of Streptococcus Pneumoniae In Unvaccinated Toddlers At The Time of Pneumococcal Conjugate Vaccine Implementation Into The National Immunization Program In Poland

We investigated pneumococcal carriage among unvaccinated children under five years of age at the time of conjugate polysaccharide vaccine (PCV) introduction into the national immunization program (NIP). Paired nasopharyngeal swab (NPS) and saliva samples collected between 2016 and 2020 from n=394 children were tested with conventional culture and using qPCR. The carriage rate detected by culture was 25.4% (97 of 394), by qPCR 39.1% (155 of 394), and 40.1% (158 of 394) overall. The risk of carriage was significantly elevated among day care center attendees, and during autumn/winter months. Among strains cultured, the most common serotypes were: 23A, 6B, 15BC, 10A, 11A. The coverage of PCV10 and PCV13 was 23.2% (23 of 99) and 26.3% (26 of 99), respectively. Application of qPCR lead to detection of 168 serotype carriage events, with serogroups 15, 6, 9 and serotype 23A most commonly detected. Although the highest number of carriers was identified by testing NPS with qPCR, saliva significantly contributed to the overall number of detected carriers. Co-carriage of multiple serotypes was detected in 25.3% (40 of 158) of carriers. Results of this study represent a baseline for the future surveillance of effects of pneumococcal vaccines in NIP in Poland.

Economic assessment of incorporating the Hexavalent vaccine as part of the National Immunization Program of Peru

Background This study aimed to estimate the economic impact of replacing the current Peruvian primary immunization scheme for infants under 1 year old with an alternative scheme with similar efficacy, based on a hexavalent vaccine. Methods A cost-minimization analysis compared the costs associated with vaccine administration, adverse reactions medical treatment, logistical activities, and indirect social costs associated with time spent by parents in both schemes. A budgetary impact analysis assessed the financial impact of the alternative scheme on healthcare budget. Results Incorporating the hexavalent vaccine would result in a 15.5% net increase in healthcare budget expenditure ($48,281,706 vs $55,744,653). Vaccination costs would increase by 54.1%, whereas logistical and adverse reaction costs would be reduced by 59.8% and 33.1%, respectively. When including indirect social costs in the analysis, the budgetary impact was reduced to 8.7%. Furthermore, the alternative scheme would enable the liberation of 17.5% of national vaccines storage capacity. Conclusions Despite of the significant reduction of logistical and adverse reaction costs, including the hexavalent vaccine into the National Immunization Program of Peru in place of the current vaccination scheme for infants under 1 year of age would increase the public financial budget of the government as it would represent larger vaccine acquisition costs. Incorporating the indirect costs would reduce the budgetary impact demonstrating the social value of the alternative scheme. This merits consideration by government bodies, and future studies investigating such benefits would be informative.

Economic Impact of Switching From Partially Combined Vaccine “Pentaxim ® and Hepatitis B” to Fully Combined Vaccine “Hexaxim ® ” in The Malaysian National Immunization Program

Background: The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents/caregivers’ perceptions.Methods: In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents/caregiver’s questionnaire. The vaccine societal cost was calculated as cost per dose, per fully immunized child and per birth cohort, and then the net cost savings were calculated upon the total cost of Hexaxim® and Pentaxim® plus hepatitis B. Also, HCPs’ and parents/caregiver’s perceptions were investigated using structured questionnaires.Results: The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® was Malaysian ringgit (RM) 31.90 vs. 17.10 (direct medical cost), RM 54.40 vs. RM 27.20 (direct non-medical cost), RM 221.33 vs. RM 110.66 (indirect cost), and RM 307.63 vs. RM 155.00 (total cost). Similar trend was observed for alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 and RM 104.70 in the baseline and alternative scheme, respectively. Conclusions: Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B.Trial registration: Not applicable