A cost-effectiveness analysis of universal versus selective immunization with Mycobacterium bovis bacille Calmette-Guérin in Finland.
METHODS
Mycobacterium bovis bacille Calmette-Gueŕin (BCG) is provided to all infants born in Finland.


OBJECTIVE
To analyze the cost-effectiveness of universal versus selective BCG immunization.


METHODS
A Markov model was developed to simulate rates of tuberculosis (TB) and non-tuberculous mycobacterial disease (NTM), and to examine the cost-effectiveness in terms of cost per case averted of three different strategies: universal BCG, selective BCG (10% of infants at higher TB risk than other infants) or no BCG immunization.


RESULTS
In a cohort of 60,000 infants over 15 years, the model predicts five cases each of TB and NTM disease with universal immunization, 8-21 TB and 31 NTM cases with various strategies of selective immunization, and 25 TB and 34 NTM cases with no BCG immunization. BCG side-effects are predicted in 5, 0.5 and 0 infants, respectively. The cost per case averted for immunization strategies ranges from a cost of 38,311 US dollars to a savings of 323 dollars as selective immunization becomes more efficient at targeting infants at highest risk of TB.


CONCLUSIONS
In a country with a low incidence of pediatric tuberculosis, selective BCG immunization is a more cost-effective strategy than universal BCG immunization for the prevention of tuberculosis, but results in an increase in NTM cases.
Hersh
A L
AL
Infectious Disease Section, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Tala-Heikkilä
M
M
Tala
E
E
Tosteson
A N A
AN
Fordham von Reyn
C
C
D001500:BCG Vaccine / Q000008:administration & dosage / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005387:Finland / Q000453:epidemiology; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D015994:Incidence; D007223:Infant; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics; D018579:Patient Selection; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*
D001500:BCG Vaccine