A COST-BENEFIT-ANALYSIS OF PROGRAMMATIC USE OF CVD 103-HGR LIVE ORAL CHOLERA VACCINE IN A HIGH-RISK POPULATION

Background. Cholera spread to Latin America in 1991;subsequently, chol era vaccination was considered as an interim intervention until long-t erm solutions involving improved water supplies and sanitation could b e introduced. Three successive summer cholera outbreaks in northern Ar gentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this n ew vaccine. Methods. This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the c osts of vaccination with CVD 103-HgR in the relatively confined popula tion of northern Argentina affected by the cholera outbreaks. Water su pplies and sanitation in this area are poor but a credible infrastruct ure for vaccine delivery exists. Results. In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-pati ents per 1000 population and assumptions of vaccine efficacy of 75% an d coverage of 75%, vaccination of targeted high risk groups would prev ent 1265 cases. Conclusion. Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132 100. The projec ted savings would be altered less by vaccine coverage (range 75-90%) o r efficacy (60-85%) changes than by disease incidence changes. Our ana lysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; indirect losses to trade and tour ism had the greatest economic impact. However, vaccination with CVD 10 3-HgR was still cost-beneficial in the base case.