The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: A disease modeling and economic analysis

• Published in: PLoS neglected tropical diseases Vol. 12; no. 10; p. e0006652
• Main Authors: Khan, Ashraful Islam, Levin, Ann, Chao, Dennis L, DeRoeck, Denise, Dimitrov, Dobromir T, Khan, Jahangir A M, Islam, Muhammad Shariful, Ali, Mohammad, Islam, Md Taufiqul, Sarker, Abdur Razzaque, Clemens, John D, Qadri, Firdausi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.10.2018; Public Library of Science (PLoS)
• Subjects: Age groups; Biology and Life Sciences; Cholera; Cost analysis; Costs; Disease control; Disease transmission; Dosage; Drug dosages; Dynamic models; Economic analysis; Economic models; Epidemiology; Feasibility studies; Hospitals; Incidence; Infections; Infectious diseases; Low income groups; Medical research; Medicine and Health Sciences; Migration; People and Places; Population; Populations; Public health; Ratios; Slums; Social Sciences; Systematic review; Transmission; Tropical diseases; Vaccination; Vaccine efficacy; Vaccines; Waterborne diseases; Bangladesh; United Kingdom > UK; United States > US; India
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0006652

Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations. Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group. Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.