title: Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa.
abstract: BACKGROUND
  Tuberculosis remains the leading cause of death in South Africa. A number of potential new TB vaccine candidates have been identified and are currently in clinical trials. One such candidate is MVA85A. This study aimed to estimate the cost-effectiveness of adding the MVA85A vaccine as a booster to the BCG vaccine in children from the perspective of the South African government.
  
  
  METHODS
  The cost-effectiveness was assessed by employing Decision Analytic Modelling, through the use of a Markov model. The model compared the existing strategy of BCG vaccination to a new strategy in which infants receive BCG and a booster vaccine, MVA85A, at 4 months of age. The costs and outcomes of the two strategies are estimated through modelling the vaccination of a hypothetical cohort of newborns and following them from birth through to 10 years of age, employing 6-monthly cycles.
  
  
  RESULTS
  The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective - there are fewer TB cases and deaths from TB than BCG alone. The South African government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. The threshold analysis shows that, if the efficacy of the MVA85A vaccine was 41.3% (instead of the current efficacy of 17.3%), the two strategies would have the same cost but more cases of TB and more deaths from TB would be prevented by adding the MVA85A vaccine to the BCG vaccine. In this case, the government chould consider the MVA85A strategy.
  
  
  CONCLUSIONS
  At the current level of efficacy, the MVA85A vaccine is neither effective nor cost-effective and, therefore, not a good use of limited resources. Nevertheless, this study contributes to developing a standardized Markov model, which could be used, in the future, to estimate the potential cost-effectiveness of new TB vaccines compared to the BCG vaccine, in children between the ages of 0-10 years. It also provides an indicative threshold of vaccine efficacy, which could guide future development.
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa.
authors.forename: Liezl
authors.initials: L
authors.lastname: Channing
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa.
authors.forename: Edina
authors.initials: E
authors.lastname: Sinanovic
keywords: BCG vaccine; Childhood TB; Cost-effectiveness analysis; Markov modelling; New TB vaccine; South Africa; Tuberculosis