title: Cost-benefit of WC/rBS oral cholera vaccine for vaccination against ETEC-caused travelers' diarrhea.
abstract: BACKGROUND
  The most common infectious health problem encountered by travelers to countries in the developing region is travelers' diarrhea (TD), with enterotoxigenic Escherichia coli (ETEC) being the most common pathogen isolated. Although mild in most cases, the disease still leads to the loss of a significant part of a vacation or business trip. There is currently a lack of knowledge about the costs in relation to the benefits of vaccination against TD caused by ETEC, and the purposes of this study were to estimate and develop a cost-benefit analysis of vaccination using whole-cell/recombinant-B-subunit oral cholera vaccine.
  
  
  METHODS
  The consequences of the vaccination were identified and quantified in monetary terms. The cost-benefits for leisure and business travelers were assessed separately. The value of the travel was separated into the cost of the trip and of lost leisure time/business opportunities. A person with TD was in base case estimated to lose on average 3.5 days of a 7-day leisure trip and 2.5 days of a 4-day business trip. Results are presented for a Canadian traveler to endemic areas in year 2007 in US$.
  
  
  RESULTS
  The average cost of a TD event was estimated at $1,460 and $1,996 for leisure and business travelers, respectively. The net value of the vaccination, however, varied with the risk of the disease. Through extensive literature searches, an updated ETEC map illustrating the proportion of ETEC-caused TD was created.
  
  
  CONCLUSIONS
  The analysis indicated that vaccination would be considered cost-effective at incidence rates of ETEC-caused TD above about 13 and 9% for leisure and business travelers, respectively. It is, however, important to keep in mind that it is the value of the travel for the individual traveler that will decide if the vaccination provides good value for money.
authors.affiliation: i3Innovus, Stockholm, Sweden. jonas.lundkvist@ki.se
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundkvist
authors.forename: Robert
authors.initials: R
authors.lastname: Steffen
authors.forename: Bengt
authors.initials: B
authors.lastname: Jönsson
mesh_terms: D000284:Administration, Oral; D022121:Cholera Vaccines / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D054307:Enterotoxigenic Escherichia coli; D004927:Escherichia coli Infections / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D014195:Travel
chemical_list: D022121:Cholera Vaccines