# Evaluation of rotavirus, pneumococcal conjugate and human papillomavirus vaccination in four Pacific island countries: A cost-effectiveness modelling study

## TL;DR

This study evaluates whether introducing three vaccines in four Pacific island countries is cost-effective and finds that while beneficial, it requires significant budget increases.

## Contribution

The study provides new cost-effectiveness and budget impact evidence for introducing three vaccines in four Pacific island countries using locally relevant data.

## Key findings

- Introducing all three vaccines could prevent over 1,000 deaths in vaccinated cohorts.
- Cost per DALY averted ranged from 42% to 73% of GDP at PAHO prices.
- Budget impact ranged from 359% (Samoa) to 1,368% (Vanuatu) of 2019 vaccine budgets.

## Abstract

The introduction of rotavirus vaccine (RVV), pneumococcal conjugate vaccine (PCV) and human papillomavirus vaccine (HPVV) has been slow in Pacific Island Countries, particularly among middle-income countries. To assist decision-making on the simultaneous introduction of these three vaccines, cost-effectiveness and budget impact evaluations were undertaken in Samoa, Tonga, Tuvalu and Vanuatu, using locally relevant data.

A proportionate outcomes model was used to evaluate vaccine introduction in each country from a health systems perspective, using country-specific data supplemented with regional and global estimates. A 10-year vaccination program was modelled from 2021, with costs and outcomes (disability-adjusted life years [DALYs]) summed over a life-time horizon and discounted at 3%. Vaccine dose costs were based on Pan American Health Organization (PAHO) Revolving Fund prices, with lower-priced products also explored. Introduction of all three vaccines in all countries could prevent over 1,000 deaths over the lifetimes of the vaccinated cohorts. The cost per DALY averted at PAHO Revolving Fund prices ranged from 42% to 73% of the per capita gross domestic product (GDP) in each country, and 15% to 58% for lower-priced vaccines. The budget impact ranged from 359% (Samoa) to 1,368% (Vanuatu) of the 2019 vaccine budgets, and 149% (Samoa) to 775% (Vanuatu) for lower-priced vaccines. Cost-effectiveness results were most sensitive to disease burden, discount rate, vaccine efficacy, and program costs. A limitation of our study is the reliance on data from Fiji to inform disease burden, as availability of country-specific data was limited.

With development partner support, introduction of HPVV, PCV and RVV may represent good value for money in Samoa, Tonga, Tuvalu and Vanuatu, depending on willingness to pay thresholds. However, inclusion of these three vaccines will place considerable burden on immunisation budgets. Financial sustainability requires increases in immunisation budgets and negotiation of affordable vaccine prices. This analysis provides evidence of the benefit of introducing new vaccines, but shows the importance of affordable pricing to ensure sustainability for small Pacific Island countries.

Effective vaccines against pneumococcus, rotavirus and human papillomavirus have been available on the market for over a decade but are yet to be introduced into routine immunisation programs in some Pacific Island countries, with substantial consequences for population health.

This study was commissioned by policy-makers from Samoa, Tonga, Tuvalu and Vanuatu and development partners to provide evidence to support decisions on whether to introduce three new vaccines into the immunisation schedule.

We analysed the costs and health impacts of simultaneous introduction of pneumococcal conjugate vaccine, rotavirus vaccine and human papillomavirus vaccine in Samoa, Tonga, Tuvalu and Vanuatu, with development partner assistance.

We show that introducing all three vaccines (at prices currently accessible to these countries) is good value for money in all four countries based on thresholds used by decision-makers at the time the program was adopted.

Access to cheaper vaccines would be necessary for this program to be good value for money according to more recent thresholds which consider constraints in health budgets.

The estimated annual costs of the vaccination program represented 359% (Samoa) to 1,368% (Vanuatu) of the 2019 vaccine budgets.

Introduction of these vaccines may be a cost-effective way to improve population health in Pacific-Island countries, depending on vaccine pricing and thresholds used to determine value for money.

We demonstrate that substantial increases in the immunisation budget are required to finance these vaccines, particularly in the longer term with development partner assistance scaling down over time.

These findings provide evidence for the benefit of introducing new vaccines, but show the importance of affordable pricing to ensure sustainability for small Pacific Island countries.

A limitation of our study is that much of the input into our model was data from Fiji because country-specific data that could be used for analysis were scarce.

In a modelling study, Natalie Carvalho and colleagues assessed the cost-effectiveness of simultaneously introducing rotavirus, pneumococcal conjugate and human papillomavirus vaccination in the Pacific Island countries Samoa, Tonga, Tuvalu and Vanuatu.