Objective

To estimate neonatal health benefits and healthcare provider costs of a theoretical Group B streptococcal (GBS) hexavalent maternal vaccination programme in The Gambia, a low-income setting in West Africa.

Methods

A static decision analytic cost-effectiveness model was developed from the healthcare provider perspective. Demographic data and acute care costs were available from studies in The Gambia undertaken in 2012–2015. Further model parameters were taken from United Nations and World Health Organisation sources, supplemented by data from a global systematic review of GBS and literature searches. As vaccine efficacy is not known, we simulated vaccine efficacy estimates of 50–90%. Costs are reported in US dollars. Cost-effectiveness thresholds of one (US$473, very cost effective) and three (US$1420, cost effective) times Gambian GDP were used.

Results

Vaccination with a hexavalent vaccine would avert 24 GBS disease cases (55%) and 768 disability adjusted life years compared to current standard of care (no interventions to prevent GBS disease). At vaccine efficacy of 70%, the programme is cost-effective at a maximum vaccine price per dose of 12 US$ (2016 US$), and very cost-effective at a maximum of $3/dose. The total costs of vaccination at $12 is $1,056,962 for one annual cohort of Gambian pregnant women. One-way sensitivity analysis showed that GBS incidence was the most influential parameter on the cost effectiveness ratio.

Conclusion

The introduction of a hexavalent vaccine would considerably reduce the current burden of GBS disease in The Gambia but to be cost-effective, the vaccine price per dose would need to be $12/dose or less.

中文翻译：

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冈比亚母体 B 组链球菌疫苗的潜在成本效益。

客观的

估计冈比亚（西非的低收入地区）理论上的 B 组链球菌 (GBS) 六价孕产妇疫苗接种计划的新生儿健康效益和医疗保健提供者成本。

方法

从医疗保健提供者的角度开发了一个静态决策分析成本效益模型。人口统计数据和急症护理费用可从 2012-2015 年在冈比亚进行的研究中获得。进一步的模型参数取自联合国和世界卫生组织的来源，并辅以全球系统性审查 GBS 和文献检索的数据。由于疫苗功效未知，我们模拟了 50-90% 的疫苗功效估计值。成本以美元报告。使用冈比亚 GDP 的一倍（473 美元，非常具有成本效益）和三倍（1420 美元，具有成本效益）的成本效益阈值。

结果

与目前的护理标准（没有预防 GBS 疾病的干预措施）相比，接种六价疫苗可避免 24 例 GBS 疾病病例 (55%) 和 768 残疾调整生命年。在疫苗效力为 70% 时，该计划在每剂最高疫苗价格为 12 美元（2016 年美元）时具有成本效益，并且在最高每剂 3 美元时非常具有成本效益。每年一组冈比亚孕妇的疫苗接种费用为 12 美元，总费用为 1,056,962 美元。单向敏感性分析表明，GBS 发病率是对成本效益比影响最大的参数。

结论

引入六价疫苗将大大减轻冈比亚目前的 GBS 疾病负担，但为了具有成本效益，每剂疫苗的价格需要为 12 美元/剂或更低。