Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries
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...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-12-01
|
| Series: | Vaccine: X |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590136219300440 |
| _version_ | 1811270559772704768 |
|---|---|
| author | John D. Anderson, IV Farzana Muhib Richard Rheingans Thomas Wierzba |
| author_facet | John D. Anderson, IV Farzana Muhib Richard Rheingans Thomas Wierzba |
| author_sort | John D. Anderson, IV |
| collection | DOAJ |
| description | 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. Keywords: ETEC, Shigella, Sub-Saharan Africa, Disparities, Cost-effectiveness analysis, Subnational, Diarrhoea, Stunting |
| first_indexed | 2024-04-12T22:04:01Z |
| format | Article |
| id | doaj.art-8643672112834695b93bccb62ac5dae0 |
| institution | Directory Open Access Journal |
| issn | 2590-1362 |
| language | English |
| last_indexed | 2024-04-12T22:04:01Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Vaccine: X |
| spelling | doaj.art-8643672112834695b93bccb62ac5dae02022-12-22T03:15:00ZengElsevierVaccine: X2590-13622019-12-013Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countriesJohn D. Anderson, IV0Farzana Muhib1Richard Rheingans2Thomas Wierzba3Goodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USA; Corresponding author at: 2005 Cesar Chavez Avenue, Austin, TX 78702, USA.PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USAGoodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USAPATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USADiarrheal 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. Keywords: ETEC, Shigella, Sub-Saharan Africa, Disparities, Cost-effectiveness analysis, Subnational, Diarrhoea, Stuntinghttp://www.sciencedirect.com/science/article/pii/S2590136219300440 |
| spellingShingle | John D. Anderson, IV Farzana Muhib Richard Rheingans Thomas Wierzba Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries Vaccine: X |
| title | Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries |
| title_full | Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries |
| title_fullStr | Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries |
| title_full_unstemmed | Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries |
| title_short | Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries |
| title_sort | heterogeneity in potential impact and cost effectiveness of etec and shigella vaccination in four sub saharan african countries |
| url | http://www.sciencedirect.com/science/article/pii/S2590136219300440 |
| work_keys_str_mv | AT johndandersoniv heterogeneityinpotentialimpactandcosteffectivenessofetecandshigellavaccinationinfoursubsaharanafricancountries AT farzanamuhib heterogeneityinpotentialimpactandcosteffectivenessofetecandshigellavaccinationinfoursubsaharanafricancountries AT richardrheingans heterogeneityinpotentialimpactandcosteffectivenessofetecandshigellavaccinationinfoursubsaharanafricancountries AT thomaswierzba heterogeneityinpotentialimpactandcosteffectivenessofetecandshigellavaccinationinfoursubsaharanafricancountries |