Cost-effectiveness of maternal influenza immunization in Bamako, Mali: A decision analysis

• Type of Material: Article
• Authors: Evan Orenstein, Emory University; Lauren A. V. Orenstein, Emory University; Kounandji Diarra, Centre pour le Développement des Vaccins, Mali; Mahamane Djiteye, Centre pour le Développement des Vaccins, Mali; Diakaridia Sidibe, Centre pour le Développement des Vaccins, Mali; Fadima C. Haidara, Centre pour le Développement des Vaccins, Mali; Moussa F. Doumbia, Centre pour le Développement des Vaccins, Mali; Fatoumata Diallo, Centre pour le Développement des Vaccins, Mali; Flanon Coulibaly, Centre pour le Développement des Vaccins, Mali; Adama M. Keita, Centre pour le Développement des Vaccins, Mali; Uma Onwuchekwa, Centre pour le Développement des Vaccins, Mali; Ibrahima Teguete, Gabriel Toure Teaching Hospital; Milagritos D. Tapia, University of Maryland; Samba O. Sow, Centre pour le Développement des Vaccins, Mali; Myron M. Levine, University of Maryland; Richard Rheingans, University of Florida
• Language: English
• Date: 2017-02-07
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Orenstein et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0171499
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 12
• Issue: 2
• Start Page: e0171499
• End Page: e0171499
• Grant/Funding Information: Evan Orenstein’s participation was supported by the American Society of Tropical Medicine & Hygiene Benjamin Kean Fellowship, the Infectious Diseases Society of America Medical Scholars program, and the Emory University Global Health Institute Field Scholars program.; Lauren Orenstein’s participation was supported by the Alpha Omega Alpha Carolyn Kuckein Student Research Award, the Infectious Diseases Society of America Medical Scholars program, and the Emory University Global Health Institute Field Scholars program.; The funding sources had no role in data collection, analysis, interpretation, design, or writing of this manuscript.; The clinical trial and participation of all authors was supported by the Bill & Melinda Gates Foundation (grant OPP1002744).
• Keywords: NEONATAL TETANUS; INFANTS; COUNTRIES; Multidisciplinary Sciences; ECONOMIC BURDEN; Science & Technology - Other Topics; CHILDREN; Science & Technology; PREGNANT-WOMEN; SEASONAL INFLUENZA; HOSPITALIZATIONS; OUTPATIENT VISITS; VACCINATION
• Research Categories: Health Sciences, Immunology; Health Sciences, Obstetrics and Gynecology

Abstract

Background Maternal influenza immunization has gained traction as a strategy to diminish maternal and neonatal mortality. However, efforts to vaccinate pregnant women against influenza in developing countries will require substantial investment. We present cost-effectiveness estimates of maternal influenza immunization based on clinical trial data from Bamako, Mali. Methods We parameterized a decision-tree model using prospectively collected trial data on influenza incidence, vaccine efficacy, and direct and indirect influenza-related healthcare expenditures. Since clinical trial participants likely had better access to care than the general Malian population, we also simulated scenarios with poor access to care, including decreased healthcare resource utilization and worse influenza-related outcomes. Results Under base-case assumptions, a maternal influenza immunization program in Mali would cost $857 (95% UI: $188-$2358) per disability-adjusted life year (DALY) saved. Adjusting for poor access to care yielded a cost-effectiveness ratio of $486 (95% UI: $105-$1425) per DALY saved. Cost-effectiveness ratios were most sensitive to changes in the cost of a maternal vaccination program and to the proportion of laboratory-confirmed influenza among infants warranting hospitalization. Mean cost-effectiveness estimates fell below Mali's GDP per capita when the cost per pregnant woman vaccinated was $1.00 or less with no adjustment for access to care or $1.67 for those with poor access to care. Healthcare expenditures for lab-confirmed influenza were not significantly different than the cost of influenza-like illness. Conclusions Maternal influenza immunization in Mali would be cost-effective in most settings if vaccine can be obtained, managed, and administered for ô$1.00 per pregnant woman.