title: Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: the case of Kasese district in Uganda.
abstract: BACKGROUND
  Vaccination has been increasingly promoted to help control epidemic and endemic typhoid fever in high-incidence areas. Despite growing recognition that typhoid incidence in some areas of sub-Saharan Africa is similar to high-incidence areas of Asia, no large-scale typhoid vaccination campaigns have been conducted there. We performed an economic evaluation of a hypothetical one-time, fixed-post typhoid vaccination campaign in Kasese, a rural district in Uganda where a large, multi-year outbreak of typhoid fever has been reported.
  
  
  METHODS
  We used medical cost and epidemiological data retrieved on-site and campaign costs from previous fixed-post vaccination campaigns in Kasese to account for costs from a public sector health care delivery perspective. We calculated program costs and averted disability-adjusted life years (DALYs) and medical costs as a result of vaccination, to calculate the cost of the intervention per DALY and case averted.
  
  
  RESULTS
  Over the 3 years of projected vaccine efficacy, a one-time vaccination campaign was estimated to avert 1768 (90%CI: 684-4431) typhoid fever cases per year and a total of 3868 (90%CI: 1353-9807) DALYs over the duration of the immunity conferred by the vaccine. The cost of the intervention per DALY averted was US$ 484 (90%CI: 18-1292) and per case averted US$ 341 (90%CI: 13-883).
  
  
  CONCLUSIONS
  We estimated the vaccination campaign in this setting to be highly cost-effective, according to WHO's cost-effective guidelines. Results may be applicable to other African settings with similar high disease incidence estimates.
authors.affiliation: Office of Science and Integrated Programs, Centers for Disease Control and Prevention, Atlanta, GA, United States; IHRC Inc, Atlanta, GA, United States. Electronic address: vnn9@cdc.gov.
authors.forename: Cristina
authors.initials: C
authors.lastname: Carias
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Maroya Spalding
authors.initials: MS
authors.lastname: Walters
authors.affiliation: Kilembe Mines Hospital, Kasese, Uganda.
authors.forename: Edward
authors.initials: E
authors.lastname: Wefula
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Kashmira A
authors.initials: KA
authors.lastname: Date
authors.affiliation: Office of Science and Integrated Programs, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D014435:Typhoid Fever / Q000453:epidemiology*; D014436:Typhoid-Paratyphoid Vaccines / Q000191:economics*; D014454:Uganda / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*; D014944:World Health Organization
chemical_list: D014436:Typhoid-Paratyphoid Vaccines
keywords: Cost-effectiveness; Typhoid; Typhoid vaccination; Uganda