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					List Analysis Projects

                      LiST ANALYSIS PROJECT: Decade of Vaccine Economics
        Question:
               Impact of scaling up coverage of Pneumococcal, Hib, Rotavirus, Measles, and DTP vaccines to 90% on
               under 5 deaths averted by cause and life expectancy in 87 countries (All Countdown and GAVI eligible
               countries)

        Packages/Interventions of interest:
               Package of 5 vaccines (Pneumococcal, Hib, Rotavirus, Measles, and DTP)

        Baseline Values:

        Population trend is obtained from the The 2008 Revision of the World Population Prospects published by the
        Population Division of the United Nations Department of Economic and Social Affairs of the United Nations
        Secretariat. http://esa.un.org/unpd/wpp2008/index.htm

        Child mortality estimates are obtained from http://www.childmortality.org. The estimates from year 2008.5
        were used.

        Causes of death in children under 5 are obtained from the following article

           Black, Robert E , Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, Prabhat Jha,
            Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child
            Health Epidemiology Reference Group of WHO and UNICEF (2010). Global, regional, and national causes of
            child mortality in 2008: a systematic analysis. Lancet. 375 (9730): 1969 - 1987.

        Vaccine coverage estimates are obtained from the WHO-UNICEF estimates of national immunization coverage,
        data downloaded in Oct 2010. The estimates from year 2009 were used.
        http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm

                                                2009           2009   2009            2009           2009
            Country:                            Pneumo         Hib    Rota            Measles        DTP
            Afghanistan                                    0       83            0              76          83
            Angola                                         0       73            0              77          73
            Armenia                                        0        0            0              96          93
            Azerbaijan                                     0        0            0              67          73
            Bangladesh                                     0        0            0              89          94
            Benin                                          0       83            0              72          83
            Bhutan                                         0        0            0              98          96
            Bolivia                                        0       85            0              86          85
            Burkina Faso                                   0       81            0              75          82
            Burundi                                        0       92            0              91          92
            Cambodia                                       0        0            0              92          94
            Cameroon                                       0       80            0              74          80
            Central African Republic                       0       54            0              62          54
            Chad                                           0       22            0              23          23
            Comoros                                        0       38            0              79          83
Congo                             0   91    0   76   91
Côte d'Ivoire                     0   81    0   67   81
Cuba                              0   96    0   96   96
Dem. People's Republic of Korea   0    0    0   98   93
Democratic Republic of the
Congo                             0   77    0   76   77
Djibouti                          0   89    0   73   89
Eritrea                           0   99    0   95   99
Ethiopia                          0   79    0   75   79
Gambia                            0   98    0   96   98
Georgia                           0    0    0   83   88
Ghana                             0   94    0   93   94
Guinea                            0   58    0   51   57
Guinea-Bissau                     0   68    0   76   68
Guyana                            0   98    0   97   98
Haiti                             0    0    0   59   59
Honduras                          0   98   82   99   98
India                             0    0    0   71   66
Indonesia                         0    0    0   82   82
Kenya                             0   75    0   74   75
Kiribati                          0   86    0   82   86
Kyrgyzstan                        0    0    0   99   95
Lao People's Democratic
Republic                          0    0    0   59   57
Lesotho                           0   83    0   85   83
Liberia                           0   64    0   64   64
Madagascar                        0   78    0   64   78
Malawi                            0   93    0   92   93
Mali                              0   74    0   71   74
Mauritania                        0   64    0   59   64
Mongolia                          0   97    0   94   95
Mozambique                        0   74    0   77   76
Myanmar                           0    0    0   87   90
Nepal                             0    0    0   79   82
Nicaragua                         0   98   94   99   98
Niger                             0   70    0   73   70
Nigeria                           0    0    0   41   42
Pakistan                          0   85    0   80   85
Papua New Guinea                  0   64    0   58   64
Republic of Moldova               0   47    0   90   85
Rwanda                            0   97    0   92   97
Sao Tome and Principe             0    0    0   90   98
Senegal                           0   86    0   79   86
Sierra Leone                      0   75    0   71   75
Solomon Islands                   0   77    0   60   81
Somalia                           0    0    0   24   31
Sri Lanka                         0    0    0   96   97
   Sudan                                           0        76          0             82         84
   Tajikistan                                      0        93          0             89         93
   Timor-Leste                                     0         0          0             70         72
   Togo                                            0        89          0             84         89
   Uganda                                          0        64          0             68         64
   Ukraine                                         0        81          0             94         90
   United Republic of Tanzania                     0        85          0             91         85
   Uzbekistan                                      0        98          0             95         98
   Viet Nam                                        0         0          0             97         96
   Yemen                                           0        67          0             58         66
   Zambia                                          0        81          0             85         81
   Zimbabwe                                        0        73          0             76         73


Vaccine effectiveness is based on their impact on specific causes of death:

An affected fraction refers to the percent of a specific cause of death which can be averted by an intervention.
This refers to etiology when available.

Standard vaccine effect sizes and affected fraction used in LiST:

       Pneumococcal and Hib vaccine’s effect on pneumonia and meningitis
           o Pneumococcal vaccine (full coverage) has an effect of 0.26, meaning that full vaccination can
              prevent 26% of pneumonia deaths, and since the review is not yet finished, we are assuming the
              same effect (26%) on meningitis deaths.
           o Hib vaccine (full coverage) has an effect of 0.18. This means that full vaccination can prevent
              18% of pneumonia deaths and, since the review is not yet finished, we are also assuming the
              same effect (18%) on meningitis deaths.
           o The affected fraction for each of these vaccines is considered to be the entire population of
              pneumonia deaths because that is how the reviews were completed. Thus the presented effect
              sizes are in essence, combinations of both effectiveness of the vaccines and the affected
              fraction, or proportion of pneumonia due to these bacteria.
           o Reference: Theodoratou, Evropi, Sue Johnson, Arnoupe Jhass, Shabir A Madhi, Andrew Clark,
              Cynthia Boschi-Pinto, Sunil Bhopal, Igor Rudan, Harry Campbell (2010). The effect of
              Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia
              incidence, severe morbidity and mortality. Int. J. Epidemiol. 39: i172-i185.

       Rotavirus vaccine’s effect on diarrhea
           o Rotavirus vaccine can prevent 74% of diarrhea deaths, and 39% of diarrhea deaths can benefit
                by full coverage of the vaccine.
           o For the purpose of this analysis, 5 different Rota vaccine effect sizes were used instead of the
                standard effect size of 74%. Countries were categorized as 'Africa', 'Low mortality Asia', 'High
                mortality Asia', 'Latin America', and 'Developed', and their effect sizes as follow
                 Africa: 49.7%
                 Low mortality Asia: 87.9%
                 High mortality Asia: 42.7%
                 Latin America: 81%
                 Developed: 90.6%
       Measles vaccine’s effect on measles
           o Measles vaccine can prevent 85% of measles deaths, and 100% of measles deaths can benefit by
               full coverage of the vaccine.

       DPT vaccine’s effect on pertussis.
           o DPT vaccine (3 doses) has an effect of 0.85, meaning that full vaccination can prevent 85% of
               pertussis deaths.
           o It is assumed that all (100%) pertussis deaths can benefit by full coverage of the vaccine.

Target values:
        Baseline year: 2010
        Target year: 2015
        Package of all 5 vaccines with coverage linearly scaled up to 90% in 2015, and coverage is held constant
        through 2020

LiST Version Used:
        Spectrum 4.2 Beta 7

Outputs of Interest:
       Under 5 deaths by cause – Pneumonia, Meningitis, Diarrhea, Measles, Pertussis, Malaria
       Life expectancy
       Deaths averted

Results:
    More than 350,000 deaths due to pneumonia, more than 200,000 deaths due to diarrhea, and a
         minimum of 50,000 deaths due to meningitis could be averted by increasing vaccine coverage to 90%
         through 2020 in children 1-59 months of age.
    More than 700,000 deaths averted in total by increasing vaccine coverage to 90% through 2020 in
         children 1-59 months of age.

				
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posted:10/15/2011
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