Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 224, Issue -, Pages S612-S624Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiab150
Keywords
typhoid; enteric fever; vaccines; India; cost-effectiveness; model
Categories
Funding
- Bill & Melinda Gates Foundation [OPP1159351]
- National Science Foundation's Graduate Research Fellowship
- Stanford Graduate Fellowship in Science and Engineering
- University of California, San Francisco Department of Medicine
- Bill and Melinda Gates Foundation [OPP1159351] Funding Source: Bill and Melinda Gates Foundation
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The study suggests that implementing routine and campaign typhoid vaccination strategies in India is cost-saving and highly cost-effective. Combining catch-up campaigns with routine vaccination can prevent millions of cases and save billions of dollars over a 10-year period.
Background. Typhoid fever causes substantial global mortality, with almost half occurring in India. New typhoid vaccines are highly effective and recommended by the World Health Organization for high-burden settings. There is a need to determine whether and which typhoid vaccine strategies should be implemented in India. Methods. We assessed typhoid vaccination using a dynamic compartmental model, parameterized by and calibrated to disease and costing data from a recent multisite surveillance study in India. We modeled routine and 1-time campaign strategies that target different ages and settings. The primary outcome was cost-effectiveness, measured by incremental cost-effectiveness ratios (ICERs) benchmarked against India's gross national income per capita (US$2130). Results. Both routine and campaign vaccination strategies were cost-saving compared to the status quo, due to averted costs of illness. The preferred strategy was a nationwide community-based catchup campaign targeting children aged 1-15 years alongside routine vaccination, with an ICER of $929 per disability-adjusted life-year averted. Over the first 10 years of implementation, vaccination could avert 21-39 million cases and save $1.6-$2.2 billion. These findings were broadly consistent across willingness-to-pay thresholds, epidemiologic settings, and model input distributions. Conclusions. Despite high initial costs, routine and campaign typhoid vaccination in India could substantially reduce mortality and was highly cost-effective.
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