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Open AccessArticle

Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

1
Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
2
Department of Clinical and Community Pharmacy, Universitas Jember, Jember 68121, Indonesia
3
Unit of Pharmaco-Therapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
4
Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto 53182, Indonesia
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Department of Pulmonary Diseases & Tuberculosis, University Medical Center Groningen, 9713 AV Groningen, The Netherlands
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Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9747 AE Groningen, The Netherlands
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Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya 60132, Indonesia
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Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 45363, Indonesia
*
Author to whom correspondence should be addressed.
Vaccines 2020, 8(4), 707; https://doi.org/10.3390/vaccines8040707
Received: 20 October 2020 / Revised: 13 November 2020 / Accepted: 20 November 2020 / Published: 26 November 2020
(This article belongs to the Special Issue Health Economics of Vaccines)
Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries. View Full-Text
Keywords: cost-effectiveness analysis; BCG; vaccine; tuberculosis cost-effectiveness analysis; BCG; vaccine; tuberculosis
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MDPI and ACS Style

Machlaurin, A.; Dolk, F.C.K.; Setiawan, D.; van der Werf, T.S.; Postma, M.J. Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study. Vaccines 2020, 8, 707. https://doi.org/10.3390/vaccines8040707

AMA Style

Machlaurin A, Dolk FCK, Setiawan D, van der Werf TS, Postma MJ. Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study. Vaccines. 2020; 8(4):707. https://doi.org/10.3390/vaccines8040707

Chicago/Turabian Style

Machlaurin, Afifah; Dolk, Franklin C.K.; Setiawan, Didik; van der Werf, Tjipke S.; Postma, Maarten J. 2020. "Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study" Vaccines 8, no. 4: 707. https://doi.org/10.3390/vaccines8040707

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