title: Comparative economic evaluation of Haemophilus influenzae type b vaccination in Belarus and Uzbekistan.
abstract: BACKGROUND
  Hib vaccine has gradually been introduced into more and more countries during the past two decades, partly due to GAVI Alliance support to low-income countries. However, since Hib disease burden is difficult to establish in settings with limited diagnostic capacities and since the vaccine continues to be relatively expensive, some Governments remain doubtful about its value leading to concerns about financial sustainability. Similarly, several middle-income countries have not introduced the vaccine. The aim of this study is to estimate and compare the cost-effectiveness of Hib vaccination in a country relying on self-financing (Belarus) and a country eligible for GAVI Alliance support (Uzbekistan).
  
  
  RESULTS
  A decision analytic model was used to estimate morbidity and mortality from Hib meningitis, Hib pneumonia and other types of Hib disease with and without the vaccine. Treatment costs were attached to each disease event. Data on disease incidence, case fatality ratios and costs were primarily determined from national sources. For the Belarus 2009 birth cohort, Hib vaccine is estimated to prevent 467 invasive disease cases, 4 cases of meningitis sequelae, and 3 deaths, while in Uzbekistan 3,069 invasive cases, 34 sequelae cases and 341 deaths are prevented. Estimated costs per discounted DALY averted are US$ 9,323 in Belarus and US$ 267 in Uzbekistan.
  
  
  CONCLUSIONS
  The primary reason why the cost-effectiveness values are more favourable in Uzbekistan than in Belarus is that relatively more deaths are averted in Uzbekistan due to higher baseline mortality burden. Two other explanations are that the vaccine price is lower in Uzbekistan and that Uzbekistan uses a three dose schedule compared to four doses in Belarus. However, when seen in the context of the relative ability to pay for public health, the vaccine can be considered cost-effective in both countries.
authors: Hib Initiative, London School of Hygiene and Tropical Medicine, London, United Kingdom. ulla.griffiths@lshtm.ac.uk
authors: Ulla K
authors: UK
authors: Griffiths
authors: Andrew
authors: A
authors: Clark
authors: Veronika
authors: V
authors: Shimanovich
authors: Irina
authors: I
authors: Glinskaya
authors: Dilorom
authors: D
authors: Tursunova
authors: Lucia
authors: L
authors: Kim
authors: Liudmila
authors: L
authors: Mosina
authors: Rana
authors: R
authors: Hajjeh
authors: Karen
authors: K
authors: Edmond
mesh_terms: D016667:Bacterial Capsules / Q000008:administration & dosage / Q000191:economics*; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018073:Haemophilus Vaccines / Q000008:administration & dosage / Q000191:economics*; D006305:Health Status Indicators; D006801:Humans; D008583:Meningitis, Haemophilus / Q000191:economics / Q000453:epidemiology / Q000276:immunology; D002094:Republic of Belarus / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014610:Uzbekistan / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*
chemical_list: D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine