The Economic Benefits of Scaling up Vaccines against Pneumonia and MeningiHs in 14 Middle Income Countries Meghan L Stack1, Sachiko Ozawa1, Yvonne Tam1, Damian G Walker2, Orin S Levine1 1 InternaHonal Vaccine Access Center, Department of InternaHonal Health, Johns Hopkins Bloomberg School of Public Health, BalHmore, MD USA 2The Bill and Melinda Gates FoundaHon, SeaUle, Washington, USA INTRODUCTION RESULTS Much of child health research and funding support focuses on the world’s poorest countries, leaving middle-­‐income countries with less evidence to assess the benefits of interven)ons. Vaccines remain one of the most cost-­‐effec)ve health interven)ons and may result in considerable economic benefits in middle-­‐income countries despite limited interna)onal support. This study projects the poten)al economic benefits of scaling up Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine (PCV) over the Decade of Vaccines (2011-­‐2020) in 14 non-­‐GAVI eligible middle-­‐income countries. Results from LiST show that scaling up PCV and Hib vaccine to current DTP3 coverage could save 285,000 child lives over the next 10 years. See Figure 1 for country distribu)on. TABLE 1 PCV and Hib vaccine coverage 14 non-­‐GAVI eligible middle-­‐income was raised from 2010 levels to countries used in analysis current DTP3 coverage over 1-­‐3 2010 years (depending on the size of WB DTP3 Surviving the country). WHO Income Cover Infants Health Impact We used the Lives Saved Tool (LiST)1 to es)mate the impact of scaling up PCV and Hib vaccine coverage on child mortality. Country-­‐ and disease-­‐specific case fatality ra)os were used to project the number of cases that would be averted. Cost of Illness3 Treatment costs Using exis)ng evidence and WHO-­‐CHOICE 2 , direct and indirect costs of vaccine-­‐
preventable pneumonia and m e n i n g i ) s c a s e s w e r e es)mated for each country and applied to the projected number of averted cases that would have sought care as measured by Demographic Health Surveys (DHS). Country Reg. Group Botswana AFR UMIC Brazil AMR UMIC China WPR UMIC Egypt EMR LMIC Gabon AFR UMIC Guatemala AMR LMIC Iraq EMR LMIC Mexico AMR UMIC Morocco EMR LMIC Peru AMR UMIC Philippines WPR LMIC South Africa AFR UMIC Swaziland AFR LMIC Turkmenistan EUR LMIC age 96 98 99 97 45 94 65 95 99 93 87 63 89 96 (‘000s) 45 2,959 16,143 1,836 39 454 1,087 2,183 604 583 2,293 1,006 32 104 35,000 5 30,000 FIGURE 1 DistribuHon of 285,000 Deaths Averted Guatem. Brazil Morocco 2% Other (7) 2% 2% 4% Iraq 8% 4 25,000 20,000 3 15,000 2 10,000 1 5,000 -­‐ -­‐ 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 13 Countries China Economic Benefits We found that scale-­‐up of PCV and Hib vaccine to current DTP3 coverage over 2011-­‐2020 would result in: •  Economic benefit of $39 billion (uncertainty range: $32.8 billion -­‐ $46.3 billion) using the cost of illness methodology •  Averted treatment costs equaling $878 million (uncertainty range: $582 million -­‐ $1.4 billion) •  Long-­‐term producHvity gains of $38 billion (uncertainty range: $31.8 billion -­‐ $44.7 billion). [considered disability + death produc)vity] TABLE 2 Cost of Illness Averted (millions 2009 US$) with uncertainty ranges Treatment Caretaker Disability Death costs producHvity producHvity producHvity Total costs averted Pneumonia 839 431 -­‐ 31,680 32,950 Meningi)s 18 1,227 4,967 6,250 58 169 9,031 9,419 449 1,227 36,647 39,200 39 Total 161 (less China) Total 878 Uncertainty Egypt 9% Billions 6 Disease (582-­‐1,439) (212-­‐624) (570-­‐2,526) (30,713-­‐42,987) (32,806-­‐46,302) CONCLUSION China 55% Philippin
Reduced caretaker output es We es)mated caretakers’ 18% improved output from vaccina)on by assuming 50% of daily wages were saved for every outpa)ent visit that was averted and 100% of daily wages were saved for every hospital bed day averted. Lost produc2vity due to premature death and long-­‐term disability Projected GDP/capita was applied to the number of produc)ve life years lost from death or major meningi)s sequelae (age 15+) that could be averted with vaccine scale up and discounted 3% annually. 40,000 Cost of Illness Averted US$ Coverage AssumpHons Annual Lives Saved and Cost of Illness Averted 2011-­‐2020 Child Deaths Averted METHODS FIGURE 2 SensiHvity analysis was performed to obtain a 95% uncertainty range. While a majority of interven)ons and research focuses on the world’s poorest countries, it is important for stakeholders to realize the large impact that improving immuniza)on access in middle-­‐income countries can have on health and economic outcomes. The results of this analysis can be used by both country-­‐level and interna)onal stakeholders to assess returns on investment in immuniza)on through both treatment savings and produc)vity gains. REFERENCES 1  Lives Saved Tool (LiST), Johns Hopkins Bloomberg School of Public Health. January, 2012. Available at: hYp://www.jhsph.edu/dept/ih/IIP/list/index.html 2  WHO. WHO-­‐CHOICE unit cost es)mates for service delivery [internet]. Geneva:WHO; July, 2011. Available from: hYp://www.who.int/choice/country/country_specific/en/index.html. 3  Stack, M., Ozawa, S., Bishai, D., et al. Es)mated Economic Benefits During the ‘Decade of Vaccines’ Include Treatment Savings, Gains in Labor Produc)vity. Health Affairs. 6;2011. © Interna)onal Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health 2012 Al Rights Reserved