Potential Cost-Effectiveness of a New Infant Tuberculosis Vaccine in South Africa - Implications for Clinical Trials: A Decision Analysis

Ditkowsky, Jared B.; Schwartzman, Kevin
January 2014
PLoS ONE;Jan2014, Vol. 9 Issue 1, p1
Academic Journal
Novel tuberculosis vaccines are in varying stages of pre-clinical and clinical development. This study seeks to estimate the potential cost-effectiveness of a BCG booster vaccine, while accounting for costs of large-scale clinical trials, using the MVA85A vaccine as a case study for estimating potential costs. We conducted a decision analysis from the societal perspective, using a 10-year time frame and a 3% discount rate. We predicted active tuberculosis cases and tuberculosis-related costs for a hypothetical cohort of 960,763 South African newborns (total born in 2009). We compared neonatal vaccination with bacille Calmette-Guérin alone to vaccination with bacille Calmette-Guérin plus a booster vaccine at 4 months. We considered booster efficacy estimates ranging from 40% to 70%, relative to bacille Calmette-Guérin alone. We accounted for the costs of Phase III clinical trials. The booster vaccine was assumed to prevent progression to active tuberculosis after childhood infection, with protection decreasing linearly over 10 years. Trial costs were prorated to South Africa's global share of bacille Calmette-Guérin vaccination. Vaccination with bacille Calmette-Guérin alone resulted in estimated tuberculosis-related costs of $89.91 million 2012 USD, and 13,610 tuberculosis cases in the birth cohort, over the 10 years. Addition of the booster resulted in estimated cost savings of $7.69–$16.68 million USD, and 2,800–4,160 cases averted, for assumed efficacy values ranging from 40%–70%. A booster tuberculosis vaccine in infancy may result in net societal cost savings as well as fewer active tuberculosis cases, even if efficacy is relatively modest and large scale Phase III studies are required.


Related Articles

  • Comparison of the Predicted Population Coverage of Tuberculosis Vaccine Candidates Ag85B-ESAT-6, Ag85BTB10.4, and Mtb72f via a Bioinformatics Approach. Davila, Jose; McNamara, Lucy A.; Zhenhua Yang // PLoS ONE;Jul2012, Vol. 7 Issue 7, p1 

    The Bacille-Calmette Guérin (BCG) vaccine does not provide consistent protection against adult pulmonary tuberculosis (TB) worldwide. As novel TB vaccine candidates advance in studies and clinical trials, it will be critically important to evaluate their global coverage by assessing the...

  • Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study. Chia-Lin Tseng; Oxlade, Olivia; Menzies, Dick; Aspler, Anne; Schwartzman, Kevin // BMC Public Health;2011, Vol. 11 Issue 1, p55 

    Background: The development of a successful new tuberculosis (TB) vaccine would circumvent many limitations of current diagnostic and treatment practices. However, vaccine development is complex and costly. We aimed to assess the potential cost effectiveness of novel vaccines for TB control in a...

  • `Poor' vaccine ruled out in TB puzzle. Day, Michael // New Scientist;7/13/96, Vol. 151 Issue 2038, p14 

    Reports on a British study designed to explain why the BCG vaccine often fails to protect against tuberculosis (TB) in developing countries. Rejection of notion that poor quality of vaccines render the TB treatment ineffective; Exposure of children in tropical countries to numerous other...

  • Improving vaccines against tuberculosis. Britton, Warwick J; Palendira, Umaimainthan // Immunology & Cell Biology;Feb2003, Vol. 81 Issue 1, p34 

    Summary Tuberculosis remains a major cause of mortality and physical and economic deprivation worldwide. There have been significant recent advances in our understanding of the Mycobacterium tuberculosis genome, mycobacterial genetics and the host determinants of protective immunity....

  • TB vaccine failure was predictable. Beverley, Peter // Nature;11/28/2013, Vol. 503 Issue 7477, p469 

    A letter to the editor is presented related to the role of the MVA85A vaccine, a tuberculosis (TB) vaccine, in the protection of TB over the Bacillus Calmette–Guérin (BCG) vaccine.

  • Editorial Response: Variation in Clinical and Immune Responses to Bacille Calmette-Guerin--Implications for an Improved Tuberculosis Vaccine.  // Clinical Infectious Diseases;4/1/1999, Vol. 28 Issue 4, p791 

    Comments on an article about the variation in clinical and immune responses to the tuberculosis vaccine bacille Calmette-Gu é rin. Concerns on the effectiveness of the vaccine; Observations on the duration of vaccine-induced ulceration; Need for further study to determine the limitations of...

  • BCG in Britain.  // British Medical Journal;9/27/1980, Vol. 281 Issue 6244, p825 

    Assesses the efficacy of BCG vaccination in treating tuberculosis in Great Britain. Mode of transmission of tuberculosis; Reduction in the incidence of tuberculosis; Complications of BCG vaccination.

  • BCG campaign may be delayed.  // Pulse;8/19/2002, Vol. 62 Issue 32, p8 

    Reports on the possible delay of the start of the BCG school vaccination campaign in Great Britain due in October 2002, following the withdrawal of the only tuberculosis vaccine approved in the country.

  • New TB vaccination programme.  // Practice Nurse;7/29/2005, Vol. 30 Issue 2, p7 

    This article reports that the British government will replace the universal BCG vaccination program with a program of targeted vaccination for individuals that have the greatest risk.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics