Journal
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
Volume 111, Issue 43, Pages 15520-15525Publisher
NATL ACAD SCIENCES
DOI: 10.1073/pnas.1404386111
Keywords
mathematical modeling; epidemiology; threshold analysis
Categories
Funding
- Aeras Grant [PHGHVK5610]
- UK Medical Research Council [MR/J005088/1]
- Bill and Melinda Gates Foundation [21675/OPP1084276, 19790.01]
- Centers for Disease Control and Prevention/the US President's Emergency Plan for AIDS Relief via the Aurum Institute [U2GPS0008111]
- Medical Research Council [MR/J005088/1] Funding Source: researchfish
- MRC [MR/J005088/1] Funding Source: UKRI
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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 adulttargeted 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.
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