young children each year. The agency estimates that about 60 percent of these deaths are caused by infection with Hib. An additional 25,000 deaths in this age group result from Hib-related meningitis. Assuming that the Hib vaccine is administered with DTP and that vaccine coverage averages about 70 percent for each of three doses, as many as 167,000 deaths, or roughly half of those expected, could be averted. If herd immunity were established, 90 percent of expected deaths could be prevented.

Based on a cohort of 127 million children, a vaccine cost of $1, and vaccine wastage of 50 percent, it would cost $276 million (for a two-dose vaccine) or $413 million (for a three-dose vaccine) to achieve these results. There would be no additional expense associated with delivering the vaccine, since it would be mixed in a vial with DTP. Adding the costs of side effects (between $2.3 and $3.5 million) and subtracting treatment expenses that were not incurred (about $3 million), CDC calculated the costs per death averted, with no herd immunity, at between $1,640 and $2,881 (Table 3). Hib cost-effectiveness is highly dependent on vaccine pricing. The current U.S. public-sector price for Merck’s Hib conjugate is $5.50 per dose; using this figure in the calculation yields a per-death-averted cost of $9,020.

TABLE 3 Cost-Effectiveness of Immunization with Hib Conjugate

 

Cost per Death Averted

Cost per Case Averted

HbOC (Connaught)

$2,628–$2,881

$462–$506

PRP-OMP (Merck)

1,640–2,331

288–410

PRP-OMP with herd immunity

994

140

NOTE: It is assumed that all vaccines are administered with DTP.

SOURCE: CDC, 1994.

Brazil recently undertook a cost-effectiveness analysis of Hib vaccine, focusing on the vaccine’s role in preventing meningitis rather than pneumonia.31 Based on data from 1992, public health officials there estimated the country experiences 1,547 cases of Hib-caused meningitis each year in children under age

31  

It should be noted that this analysis did not attempt to calculate the value of lives saved or of disability averted through the use of Hib vaccine.



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