Vaccination program in a resource-limited setting: A case study in the Philippines.

OBJECTIVE: Implementing national-level vaccination programs involves long-term investment, which can be a significant financial burden, particularly in resource-limited settings. Although many studies have assessed the economic impacts of providing vaccinations, evidence on the positive and negative implications of human resources for health (HRH) is still lacking. Therefore, this study aims to estimate the HRH impact of introducing pneumococcal conjugate vaccine (PCV) using a model-based economic evaluation. METHODS: This study adapted a Markov model from a prior study that was conducted in the Philippines for assessing the cost-effectiveness of 10-valent and 13-valent PCV compared to no vaccination. The Markov model was used for estimating the number of cases of pneumococcal-related diseases, categorized by policy options. HRH-related parameters were obtained from document reviews and interviews using the quantity, task, and productivity model (QTP model). RESULTS: The number of full-time equivalent (FTE) of general practitioners, nurses, and midwives increases significantly if the universal vaccine coverage policy is implemented. A universal coverage of PCV13 - which is considered to be the best value for money compared to other vaccination strategies - requires an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives; it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists, and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy. CONCLUSION: This is the first attempt to estimate the impact of HRH alongside a model-based economic evaluation study, which can be eventually applied to other vaccine studies, especially those which inform resource allocation in developing settings where not only financial resources but also HRH are constrained.

Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines.

OBJECTIVES: The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies. METHODS: A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. RESULTS: With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program. CONCLUSION: The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.