Cost-effectiveness of maternal influenza immunization in Bamako, Mali: A decision analysis.
BACKGROUND
Maternal influenza immunization has gained traction as a strategy to diminish maternal and neonatal mortality. However, efforts to vaccinate pregnant women against influenza in developing countries will require substantial investment. We present cost-effectiveness estimates of maternal influenza immunization based on clinical trial data from Bamako, Mali.


METHODS
We parameterized a decision-tree model using prospectively collected trial data on influenza incidence, vaccine efficacy, and direct and indirect influenza-related healthcare expenditures. Since clinical trial participants likely had better access to care than the general Malian population, we also simulated scenarios with poor access to care, including decreased healthcare resource utilization and worse influenza-related outcomes.


RESULTS
Under base-case assumptions, a maternal influenza immunization program in Mali would cost $857 (95% UI: $188-$2358) per disability-adjusted life year (DALY) saved. Adjusting for poor access to care yielded a cost-effectiveness ratio of $486 (95% UI: $105-$1425) per DALY saved. Cost-effectiveness ratios were most sensitive to changes in the cost of a maternal vaccination program and to the proportion of laboratory-confirmed influenza among infants warranting hospitalization. Mean cost-effectiveness estimates fell below Mali's GDP per capita when the cost per pregnant woman vaccinated was $1.00 or less with no adjustment for access to care or $1.67 for those with poor access to care. Healthcare expenditures for lab-confirmed influenza were not significantly different than the cost of influenza-like illness.


CONCLUSIONS
Maternal influenza immunization in Mali would be cost-effective in most settings if vaccine can be obtained, managed, and administered for ≤$1.00 per pregnant woman.
Emory University School of Medicine, Atlanta, Georgia, United States of America.|Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Evan W
http://orcid.org/0000-0003-3756-8575
EW
Orenstein
Emory University School of Medicine, Atlanta, Georgia, United States of America.|Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Lauren A V
LA
Orenstein
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Kounandji
K
Diarra
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Mahamane
M
Djiteye
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Diakaridia
D
Sidibé
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Fadima C
FC
Haidara
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Moussa F
MF
Doumbia
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Fatoumata
F
Diallo
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Flanon
F
Coulibaly
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Adama M
AM
Keita
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.
Uma
U
Onwuchekwa
Department of Obstetrics and Gynecology, Gabriel Touré Teaching Hospital, Bamako, Mali.
Ibrahima
I
Teguete
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
Milagritos D
MD
Tapia
Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.|Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
Samba O
SO
Sow
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
Myron M
MM
Levine
Department of Environmental & Global Health, University of Florida, Gainesville, Florida, United States of America.
Richard
R
Rheingans
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007252:Influenza Vaccines / Q000191:economics* / Q000276:immunology; D007251:Influenza, Human / Q000517:prevention & control*; D008302:Mali / Q000453:epidemiology; D018811:Maternal Exposure; D011247:Pregnancy; D014611:Vaccination / Q000191:economics*
D007252:Influenza Vaccines