A paper by Joseph H. Cook titled "Evaluating Investments in Typhoid Vaccines in Two Kolkata Slums" was accepted for publication in the Journal of Health, Population and Nutrition.
Abstract
New-generation vaccines against typhoid have the potential to reduce disease burden in areas where typhoid is endemic. We examine the case for public expenditures on typhoid vaccines for two low-income, high-incidence slums (Narkeldanga and Tiljala) in Kolkata, India. We take a social perspective and use three measures of the vaccine's economic benefits: avoided private and public cost-of-illness (COI); avoided COI plus mortality risk reduction benefits; and private willingness-to-pay (WTP) derived from stated preference (contingent valuation) studies that we conducted in Tiljala in 2004. The study represents a unique opportunity to evaluate typhoid vaccine programs using a wealth of new site-specific epidemiological and economic data.
We find that three typhoid vaccination strategies (targeting only enrolled school-children, targeting all children, and targeting adults and children) would most likely pass a social cost-benefit test unless the vaccine's benefits are defined to include only avoided treatment costs. All three strategies would be considered "very cost effective" using the standard comparisons of cost per DALY avoided with per capita
GDP. However, at an average total cost per immunized person of $1.1 (U.S.), typhoid programs would absorb a sixth of existing public sector spending on health (on a per capita basis) in India. We find significant private demand for the vaccines such that the government could design a financially-sustainable program with user fees. We show that a program where adults pay a higher fee to subsidize vaccines for children (who have higher incidence) would avoid more cases than a uniform user fee and still achieve revenue-neutrality.
Published on November 12, 2008
