Economic evaluation of Haemophilus influenzae type b vaccination in Moscow, Russian Federation

ObjectiveTo estimate the cost-effectiveness of providing Haemophilus influenzae type b (Hib) vaccine to children in Moscow in routine immunization services.MethodsThe incidence of Hib meningitis among children aged <5 years in Moscow was obtained from a prospective surveillance study undertaken during October 1999–September 2001, with treatment cost data collected for all cases. Sequelae in surviving children were assessed in December 2002. The costs of Hib vaccination in Moscow were estimated assuming a vaccine price of US$5 per dose and the same four-dose schedule and 97% coverage as for diphtheria–tetanus–pertussis vaccine. The most uncertain variables were varied in a sensitivity analysis.ResultsThe annual incidence of Hib meningitis was 5.7 per 100,000 children <5 years. The average treatment cost for an acute Hib meningitis case was US$1296. For a patient with sequelae, the average additional lifetime discounted treatment cost was US$15,820. The total annual cost of Hib vaccination of infants in Moscow was estimated as US$1.5 million per year. In the base case analysis, the cost-effectiveness ratios amount to US$77,503 per Hib meningitis case averted and US$10,842 per discounted disability adjusted life year averted. The break-even vaccine price, where the annual vaccination costs equal annual treatment costs averted, is only US$0.04 per dose in the base case scenario. If discounted indirect costs are included, the break-even vaccine price is US$0.5 per dose.ConclusionIn Moscow, the incidence of Hib meningitis is low and the costs of hospitalization and subsequent medical treatment are relatively inexpensive. Given these factors, Hib vaccine at US$5 per dose would not be a cost-effective option in Moscow at the present time.