Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia
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.
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Cited by (23)
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2021, Value in HealthCitation 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
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Current address: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.