Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.

Tuesday, 31st of October 2017

Vaccine. 2017 Oct 27;35(45):6187-6194. doi: 10.1016/j.vaccine.2017.09.038. Epub 2017 Sep 28.

Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo.

Doshi RH¹ Eckhoff P² Cheng A³ Hoff NA⁴ Mukadi P⁵ Shidi C⁶ Gerber S⁷ Wemakoy EO⁸ Muyembe-Tafum JJ⁹ Kominski GF¹⁰ Rimoin AW¹¹.

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Abstract

INTRODUCTION:

One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79% the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC) weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose.

METHODS:

We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children.

RESULTS:

Compared to strategy 1 (MCV1 only) strategy 2 (MCV2 by SIA) would prevent a total of 5808750 measles cases 156836 measles-related deaths and save U.S. $199 million. Compared to strategy 1 strategy 3 (MCV2 by RI) would prevent a total of 13232250 measles cases 166475 measles-related deaths and save U.S. $408 million.

DISCUSSION:

Vaccination recommendations should be tailored to each country offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.

Published by Elsevier Ltd.