title: Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries.
abstract: To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40-80% efficacy, and to be targeted at "infants" or "adolescents/adults." Vaccine prices were tiered by income group (US $1.50-$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024-2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11-24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42-1.58) million TB cases could be prevented at $1,692 ($634-$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle-, and upper-middle-income countries, respectively. Increased investments in adult-targeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies.
authors.affiliation: TB Modelling Group, TB Centre, Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, and.
authors.forename: Gwenan M
authors.initials: GM
authors.lastname: Knight
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; and.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: TB Modelling Group, TB Centre, Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, and.
authors.forename: Tom
authors.initials: T
authors.lastname: Sumner
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; and.
authors.forename: Yoko V
authors.initials: YV
authors.lastname: Laurence
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; and.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gheorghe
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; and.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.affiliation: Global Tuberculosis, World Health Organization, CH 1211 Geneva 27, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Glaziou
authors.affiliation: TB Modelling Group, TB Centre, Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, and richard.white@lshtm.ac.uk.
authors.forename: Richard G
authors.identifier: http://orcid.org/0000-0003-4410-6635
authors.initials: RG
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D002138:Calibration; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D006801:Humans; D007182:Income; D007223:Infant; D018803:Models, Economic; D014376:Tuberculosis / Q000191:economics / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D032581:Tuberculosis Vaccines / Q000191:economics*; D035501:Uncertainty
chemical_list: D032581:Tuberculosis Vaccines
keywords: epidemiology; mathematical modeling; threshold analysis