title: Cost-effectiveness of new-generation oral cholera vaccines: a multisite analysis.
abstract: OBJECTIVE
  We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects.
  
  
  METHODS
  Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older.
  
  
  RESULTS
  We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates.
  
  
  CONCLUSIONS
  Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.
authors.affiliation: Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. jeuland@email.unc.edu
authors.forename: Marc
authors.initials: M
authors.lastname: Jeuland
authors.forename: Joseph
authors.initials: J
authors.lastname: Cook
authors.forename: Christine
authors.initials: C
authors.lastname: Poulos
authors.forename: John
authors.initials: J
authors.lastname: Clemens
authors.forename: Dale
authors.initials: D
authors.lastname: Whittington
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001211:Asia, Western / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage / Q000191:economics*; D003153:Community Health Services; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D017048:Health Care Costs; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs / Q000191:economics* / Q000379:methods; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D009073:Mozambique / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012574:Schools
chemical_list: D022121:Cholera Vaccines