Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries
Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries
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DOI：
10.1016/j.jvacx.2019.100043
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发表时间：
2019-12-10
期刊：
影响因子：
3.8
通讯作者：
Wierzba, Thomas
中科院分区：
文献类型：
--
作者：
Anderson, John D.;Muhib, Farzana;Wierzba, Thomas
随着较富裕的城市人口获得清洁水、卫生设施和保健的机会增加，低收入和中低收入国家的腹泻疾病负担变得更加多样化。致肠源性大肠杆菌（ETEC）和志贺氏菌是撒哈拉以南非洲儿童腹泻死亡的五大原因之一。在此，我们探讨了在撒哈拉以南非洲四个国家引入ETEC和志贺氏菌疫苗后的第一个十年内，ETEC和志贺氏菌疾病负担的国家以下和经济异质性如何影响预计的疫苗影响和成本效益。我们为刚果民主共和国（DRC）、肯尼亚、赞比亚和津巴布韦的省级地区和儿童社会经济亚群开发了动态模型。我们估计了由于ETEC和志贺氏菌腹泻导致的死亡和发病率，以及由于ETEC和志贺氏菌诱导的发育迟缓导致的其他传染病导致的额外死亡。我们使用增量成本-效果比（ICER）分析了成本-效果比，将残疾调整生命年（DDEs）和中重度腹泻事件（MSD）作为避免因素。由于诱导发育迟缓导致的其他传染病死亡分别占省级ETEC和志贺氏菌疾病总负担的9-28%和9-32%，从2025年到2034年，这四个国家的人口增长。我们的研究结果表明，在津巴布韦，最低和最具成本效益的省DALs避免ICER分别低于600美元和500美元/DALY避免ETEC和志贺氏菌疫苗接种。赞比亚和肯尼亚的ICER最高，这两个国家所有省份的ICER都超过2，000美元/日调整生命年。国家和省级卫生部避免ICER最高的是刚果民主共和国，而最低的是肯尼亚和津巴布韦。在生活在负担最重的省份地区的较低财富亚群中，疫苗接种在避免腹泻方面是最具成本效益的。我们的方法侧重于ETEC和志贺氏菌负担的次国家异质性和疫苗接种的可及性，发现如果疫苗接种覆盖了服务不足省份的最脆弱儿童，则影响和成本效益更有利。(C)2019作者（S）由爱思唯尔有限公司发布
Diarrheal disease burden has become more heterogenous in low- and lower middle-income countries as access to clean water, sanitation and health care has increased in wealthier urban populations. Enterotoxigenic Escherichia coli (ETEC) and Shigella are among the top five causes of diarrheal mortality in children living in sub-Saharan Africa.Here, we explored how accounting for subnational and economic heterogeneity in ETEC and Shigella disease burden affects projected vaccine impact and cost-effectiveness of standalone ETEC and Shigella vaccines during the first decade after introduction in four sub-Saharan African countries. We developed dynamic models for provincial areas and socioeconomic subpopulations of children in the Democratic Republic of Congo (DRC), Kenya, Zambia, and Zimbabwe. We estimated deaths and morbidity due to ETEC and Shigella diarrhea plus additional deaths from other infectious diseases attributable to ETEC- and Shigella-induced stunting. We analyzed cost-effectiveness using Incremental Cost-Effectiveness Ratios (ICERs) with Disability-Adjusted Life Years (DALYs) and Moderate-and-Severe Diarrheal episodes (MSD) averted as denominators.Other infectious disease deaths due to induced stunting accounted for 9-28% and 9-32% of the total provincial level ETEC and Shigella disease burden, respectively, across these four countries from years 2025 to 2034. Our results indicated that the lowest and most cost-effective provincial DALYs averted ICERs were below $600 and $500/DALY averted for ETEC and Shigella vaccination, respectively in Zimbabwe. ICERs were the highest in Zambia and Kenya, where all provincial ICERs where above $2000/DALY. The highest national and provincial MSD averted ICERs were in DRC, while the lowest were in Kenya and Zimbabwe. Vaccinations were most cost-effective in averting DALYs in lower wealth subpopulations living in the highest burden provincial areas.Our approach focused on subnational heterogeneity in ETEC and Shigella burden and vaccination access found that impact and cost-effectiveness were more favorable if vaccinations reach the most vulnerable children in underserved provinces. (C) 2019 The Author(s). Published by Elsevier Ltd.