Vaccine-preventable haemophilus influenza type B disease burden and cost-effectiveness of infant vaccination in Indonesia.
BACKGROUND
Most of Asia, including Indonesia, does not use Haemophilus influenzae type b (Hib) conjugate vaccines. We estimated total vaccine-preventable disease burden and the cost-effectiveness of Hib conjugate vaccine in Indonesia.


METHODS
Hib pneumonia and meningitis incidences for children with access to health care were derived from a randomized vaccine probe study on Lombok Island, Indonesia during 1998-2002. Incidences were adjusted for limited access to care. Health system and patient out-of-pocket treatment cost data were collected concurrent with the probe study. For Hib vaccine in monovalent and combined (with DTP-HepB) presentations, we used 2007 UNICEF vaccine prices of US$3.30 and $3.75 per dose.


RESULTS
For the 2007 Indonesian birth cohort, Hib vaccine would prevent meningitis in 1 of every 179 children, pneumonia in 1 of every 18 children, and 4.9% of mortality among those younger than 5 years. The total incremental societal costs of introducing Hib vaccine in monovalent and pentavalent presentations were, respectively, US$11.74 and $8.93 per child vaccinated. Annual discounted treatment costs averted amounted to 20% of pentavalent vaccine costs. For the pentavalent vaccine, the incremental costs per discounted death and disability adjusted life-year averted amounted to US$3102 and $74, respectively, versus $4438 and $102 for monovalent vaccine.


CONCLUSIONS
Routine infant Hib vaccination would prevent a large burden of pediatric illness and death in Indonesia. Even without external funding support, Hib vaccine will be a highly cost-effective intervention in either a monovalent or pentavalent presentation based on commonly used benchmarks.
Gessner
Bradford D
BD
Agence de Médecine Préventive, Institut Pasteur, Paris, France. 106617.3011@compuserve.com
Sedyaningsih
Endang R
ER
Griffiths
Ulla K
UK
Sutanto
Agustinus
A
Linehan
Mary
M
Mercer
Dave
D
Mulholland
Edward Kim
EK
Walker
Damian G
DG
Steinhoff
Mark
M
Nadjib
Mardiati
M
D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D018073:Haemophilus Vaccines / Q000191:economics* / Q000276:immunology*; D019741:Haemophilus influenzae type b / Q000276:immunology*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008583:Meningitis, Haemophilus / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011014:Pneumonia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014611:Vaccination / Q000191:economics*; D018074:Vaccines, Conjugate / Q000191:economics / Q000276:immunology
D018073:Haemophilus Vaccines; D018074:Vaccines, Conjugate