Economic evaluation of Haemophilus influenzae type B vaccination in Indonesia: a cost-effectiveness analysis.

BACKGROUND Haemophilus influenzae type B (Hib) causes significant morbidity and mortality in children under five years of age. A safe and effective vaccine is available but is not in general use in developing countries. This paper evaluates the cost-effectiveness of introducing Hib vaccine in Indonesia as an addition to the country's current DTP-Hepatitis B vaccination program. METHODS The economic analysis uses a societal perspective and is based on a 1-year birth cohort of 4.234 million. The disease status of children with and without Hib vaccination is modeled for the year, and health consequences are modeled over the expected life of the child. One-way, two-way, probabilistic and worst-case sensitivity analyses were performed to evaluate the robustness of the results. RESULTS Implementation of Hib vaccination in Indonesia would avert approximately 76,700 cases of invasive infection, more than 7,150 deaths and 273,000 disability-adjusted life years (DALYs). Compared to no vaccine, the incremental cost-effectiveness ratio (ICER) is US $67 per DALY averted based on UNICEF pricing, whereas the program would save US $3.7 million with GAVI pricing. The result is not sensitive to uncertainty in disease incidence, costs of treatment or the probability of developing immunity. CONCLUSION The model demonstrates significant cost-effectiveness of implementation of a Hib vaccination program for Indonesian society.