Elsevier

Vaccine

Volume 26, Issue 35, 18 August 2008, Pages 4456-4460
Vaccine

Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia

https://doi.org/10.1016/j.vaccine.2008.06.050Get rights and content

Abstract

Two hypothetical birth cohorts in Bali, each consisting of 100,000 newborns, one immunized with live, attenuated JE vaccine and the other un-immunized, were modeled for JE risk over 11 years. Cumulative JE incidence before JE vaccine introduction was used to represent JE risk in the unvaccinated cohort. Data on vaccine efficacy, vaccination and treatment costs were taken from published papers and surveys. The potential immunization program averted 54 cases, 5 deaths and saved 1224 disability adjusted life years (DALYs) at a net cost of US$ 700 per JE case averted and US$ 31 per DALY saved and thus was highly cost-effective.

Introduction

Japanese encephalitis (JE), a mosquito-borne viral disease, is endemic in virtually all countries of Asia. In Bali, Indonesia, the annual JE incidence rate was estimated at 6 per 100,000 children <12 years of age; 10% of JE cases were fatal and 37% of those who survived the acute illness had neurological disability [1]. These rates are similar to those reported in other endemic regions (Taiwan and Thailand) before the introduction of JE immunizations [2], [3], [4].

A primary hamster kidney cell-derived, live-attenuated JE vaccine (SA14-14-2 strain), which is safe and effective in 1 or 2 doses [5], [6], [7], [8], [9], [10], [11], has been selected for control of JE in Bali. In this study, we assessed the cost-effectiveness of the vaccine for routine childhood JE immunization, as requested by the policymakers.

Section snippets

Decision analytical model

In our decision analytical model [12], two hypothetical birth cohorts, each consisting of 100,000 healthy children, one immunized with the live-attenuated vaccine, SA14-14-2, and the other un-immunized, were modeled for JE risk over 11 years after JE immunization. JE risk for the unvaccinated cohort was estimated by the cumulative JE incidence rate in children from birth to 12 years of age, using the average, annualized, age-specific rates reported from Bali, for 2001–2003 [1]. Estimation of

Base-case estimate

Without a JE immunization program, 63 JE cases and 6 JE deaths would occur and 1412 DALYs would be lost due to JE among 100,000 Balinese children during the 11 years after JE vaccination (Table 3, Fig. 1). The 2-dose JE immunization program would avert 54 JE cases, 5 deaths and 1224 lost DALYs among these children. Treatment of JE cases without the immunization program would cost the health care system US$ 71,144. A JE immunization program that costs US$ 99,464 would reduce the costs of

Discussion

The live-attenuated JE vaccine, given in 2 doses, provided protection for at least 11 years [6]. More studies are needed to clarify whether a third dose of the vaccine given at 10 years or beyond would be required for life-long protection. We recommend 2-dose regimen for routine childhood JE immunization program in Bali, and the net cost per DALY saved was estimated at as low as US$ 31 (2001 US$). The immunization program could be cost-saving and the net cost per DALY saved could be negative if

Acknowledgements

This project was supported by a grant from the Korean International Cooperation Agency, South Korea (contract number: 2003-138). We thank Dr. Ge de Maharoditha and Dr. Ign Sanjaya Putra for their assistances in collecting cost-of-illness data, and Professor Dewa N. Wirawan and Dr. Ge de Subrata for consultations.

References (22)

  • Z.L. Huang et al.

    Side effects of live-attenuated Japanese encephalitis vaccine

    Chin J Zoonosis

    (1998)
  • Cited by (23)

    • Expanding japanese encephalitis vaccination to selected endemic indonesia provinces: A cost-effectiveness analysis

      2022, Vaccine: X
      Citation Excerpt :

      Based on the results of hospital sentinel surveillance for JE in children under 15 years of age in 2005–2006 [8] and in 2016 [6], seven high-risk provinces with suspected endemicity of Japanese Encephalitis were identified for the Sub-National scenario, namely: Riau Islands, West Kalimantan, Jakarta, Yogyakarta, West Nusa Tenggara, East Nusa Tenggara, and North Sulawesi. JE in Bali province has been well studied and is known to have high incidence but was not included in this assessment due to the province-wide introduction of JE vaccine in 2018 and prior estimates of cost-effectiveness [9]. We collected secondary, locally-specific estimates on disease incidence, vaccine delivery costs, and cost of illness, which were used as inputs into the PATH JE economic model (Table 1) [10].

    • Economic Benefits of Immunization for 10 Pathogens in 94 Low- and Middle-Income Countries From 2011 to 2030 Using Cost-of-Illness and Value-of-Statistical-Life Approaches

      2021, Value in Health
      Citation Excerpt :

      For inpatient cases, the per diem facility cost was multiplied by the average length of stay. Additional costs of medications and diagnostics were estimated as a proportion (25%-50%) of total facility fees for all pathogens excluding JE, for which treatment costs were extrapolated from four studies.26-29 Based on a recent systematic review, proportions used to estimate medication and diagnostic costs yielded a conservative estimate of these costs.30

    • Japanese encephalitis vaccination in the Philippines: A cost-effectiveness analysis comparing alternative delivery strategies

      2020, Vaccine
      Citation Excerpt :

      Our economic findings were similar to findings reported from studies in China, Indonesia, and Cambodia that projected that vaccination would improve health outcomes while incurring moderate incremental costs compared to no vaccination. The ICERs elicited from our analysis are somewhat higher than those reported in prior studies that identified costs per DALY of $22 to $96 (original dollar values) [18,27,28]. These studies incorporated different underlying model assumptions in key parameters, including analytic perspective (i.e., whether caregiver non-medical and/or indirect costs were included), incidence rates, vaccine coverage and efficacy, number of vaccine doses, and treatment costs.

    • Japanese Encephalitis Vaccines

      2017, Plotkin's Vaccines
    View all citing articles on Scopus
    1

    Current address: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.

    View full text