Cost-effectiveness analysis of changing from live oral poliovirus vaccine to inactivated poliovirus vaccine in Australia

Objective: Estimate the economic impact of introducing inactivated poliovir us vaccine (IPV) into the Australian childhood immunisation schedule to eli minate vaccine-associated paralytic poliomyelitis (VAPP). Methods: Cost-effectiveness of two different four-dose IPV schedules (monov alent vaccine and IPV-containing combination vaccine) compared with the cur rent four-dose oral poliovirus vaccine (OPV) schedule for Australian childr en through age six years. Model used estimates of VAPP incidence, costs, an d vaccine utilisation and price obtained from published and unpublished sou rces. Main outcome measures were total costs, outcomes prevented, and incre mental cost-effectiveness, expressed as net cost per case of VAPP prevented . Results: Changing to an IPV-based schedule would prevent 0.395 VAPP cases a nnually. At $20 per dose for monovalent vaccine and $14 per dose for the IP V component in a combination vaccine, the change would incur incremental, a nnual costs of $19.5 million ($49.3 million per VAPP case prevented) and $6 .7 million ($17.0 million per VAPP case prevented), respectively. Threshold analysis identified break-even prices per dose of $1 for monovalent and $7 for combination vaccines. Conclusions: Introducing IPV into the Australian childhood immunisation sch edule is not likely to be cost-effective unless it comes in a combined vacc ine with the IPV-component price below $10. Implications: More precise estimates of VAPP incidence in Australia and IPV price are needed. However, poor cost-effectiveness will make the decision about switching from OPV to IPV in the childhood schedule difficult.