An economic evaluation of the use of Japanese encephalitis vaccine in the expanded program of immunization of Guizhou province, China.
BACKGROUND
Historically, China's Japanese encephalitis vaccination program was a mix of household purchase of vaccine and government provision of vaccine in some endemic provinces. In 2006, Guizhou, a highly endemic province in South West China, integrated JE vaccine into the provincial Expanded Program on Immunization (EPI); later, in 2007 China fully integrated 28 provinces into the national EPI, including Guizhou, allowing for vaccine and syringe costs to be paid at the national level. We conducted a retrospective economic analysis of JE integration into EPI in Guizhou province.


METHODS
We modeled two theoretical cohorts of 100,000 persons for 65 years; one using JE live-attenuated vaccine in EPI (first dose: 95% coverage and 94.5% efficacy; second dose: 85% coverage and 98% efficacy) and one not. We assumed 60% sensitivity of surveillance for reported JE rates, 25% case fatality, 30% chronic disability and 3% discounting. We reviewed acute care medical records and interviewed a sample of survivors to estimate direct and indirect costs of illness. We reviewed the EPI offices expenditures in 2009 to estimate the average Guizhou program cost per vaccine dose.


RESULTS
Use of JE vaccine in EPI for 100,000 persons would cost 434,898 US$ each year (46% of total cost due to vaccine) and prevent 406 JE cases, 102 deaths, and 122 chronic disabilities (4554 DALYs). If we ignore future cost savings and only use EPI program cost, the program would cost 95.5 US$/DALY, less than China Gross Domestic Product per capita in 2009 (3741 US$). From a cost-benefit perspective taking into account future savings, use of JE vaccine in EPI for a 100,000-person cohort would lead to savings of 1,591,975 US$ for the health system and 11,570,989 US$ from the societal perspective.


CONCLUSIONS
In Guizhou, China, use of JE vaccine in EPI is a cost effective investment. Furthermore, it would lead to savings for the health system and society.
National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Beijing 100050, China. yinzdnip@hotmail.com
Zundong
Z
Yin
Garrett R
GR
Beeler Asay
Li
L
Zhang
Yixing
Y
Li
Shuyan
S
Zuo
Yvan J
YJ
Hutin
Guijun
G
Ning
Hardeep S
HS
Sandhu
Lisa
L
Cairns
Huiming
H
Luo
D000293:Adolescent; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004672:Encephalitis, Japanese / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007115:Immunization Schedule; D007223:Infant; D022321:Japanese Encephalitis Vaccines / Q000191:economics*; D018803:Models, Economic; D009010:Monte Carlo Method; D015397:Program Evaluation; D014613:Vaccines, Attenuated / Q000191:economics*; D055815:Young Adult
D022321:Japanese Encephalitis Vaccines; D014613:Vaccines, Attenuated