Study On The Incremental Cost Of Inactivating Poliovirus Vaccine Into National Immunization Planning

Backgrounds:In order to complete the eradication poliomyelitis, the goal of the 2013-2018 Polio Eradication and Endgame Strategic Plan was formulated by The World Health Assembly (WHA). The plan plaims that we must add one dose affordable Inactivated Poliovirus Vaccine (IPV) in the global immunization program at least before 2016, and finally stop taking Oral Poliomyelitis Attenuated Live Vaccine (OPV) in 2019 to 2020. Now Chinese National Immunization Programmes (NIP) is implementing switch from OPV to IPV, they are faced with choosing proper IPV and OPV sequential vaccination schedule, and allocating healthy resources.ObjectivesAnalysis and classify global polivirus vaccine immunization strategy and vaccination schedule; Evaluation cost and effectiveness of different vaccination schedule and immunization strategy, Caluculate the break-even price that IPV or Containing Inactivated Poliovirus Combined Vaccine (Com-IPV) is introduced into NIP, Provide an economic reference data for government to choose the best immunization strategy and allocate health resources.MethodsAccording to the systerm analysis of the other global Polio vaccination programs by the end of 2014, We ascertain some immunization program which can be selected in China’s polio vaccine immunization strategy during switch process, and brought them into the incremental cost analysis.The eight selected immunization strategies are:StrategyO:4 doses of OPV, Supplement Immunization Action (SIA) twice OPVStrategyOA:real situation, people vaccinated IPV rely on out-of-pocket payments substitue free opvStrategyl:1 dose of IPV,3 doses of OPV, SIA twice OPVStrategy2:2 doses of IPV,2 doses of OPV, SIA twice OPVStrategy3:3 doses of IPV,1 dose of OPV, SIA twice OPVStrategy4:4dosesof IPV, SIA twice OPVStrategy5:4 doses of IPV only,Strategy6:4 doses of DTP/IPV;From the perspective of social, this study calculates the variation Incremental Cost (IC)、Incremental Effectiveness (IE) and Incremental Cost Effectiveness Ratio (ICER) of strategy O/OA/1/2/3/4/5/6. IC is strategy OA/1/2/3/4/5/6 subtract strategyO by the sum of the variation cost. IE is strategy OA/1/2/3/4/5/6 subtract strategyO by the sum of the variation effectiveness.We use the VAPP and the DALY to measure the effectiveness. ICER is ratio of IC and IE respectively of strategy OA/1/2/3/4/5/6. Caluculate the break-even price by sensitive analysis.ResultsPoliovirus vaccine immunization strategy switch needs substantial health resource and fund, IPV price is primary. Strategy OA/1/2/3/4/5/6 need additional central financial payment by 6.9、13.7、20.5、27.4、27.4、35.6 ten millions yuan to purchase vaccines.From the perspective of social analysis, the strategy OA IC is 1.1 billion yuan,0.4 billion yuan more than strategy 1 IC, the pattern that people vaccinated IPV rely on out-of-pocket payments substitue free opv consumed excessive social cost. The strategy OA ICER (162.4 million yuan per VAPP,424.7 million yuan per DALY) far more than other strategies. This suggests that health resource is allocated by public financial to equalize basic public health service like NIP. Strategy6, which is DTP/IPV only, reduces 4 administrates and visits each infant, as well as, reduces administrates cost, visist margin cost, and social cost.If we assuming the stragety is economic when ICER for per DALY prevention less than triple per capital GDP in 2014, the break-even price of IPV is 27.2、15.5、10.3、 7.9、14.8、46.2RMB per dose in strategy 1/2/3/4/5/6 respective. If we assuming the stragety IC is zero, the break-even price of IPV is 5.4、3.2、2.3、1.8、8.2、40.1 RMB per dose in strategy 1/2/3/4/5/6 respective. In the process of switching, we should avoid of convert the immunization strategy in the same country or region like the process from strategy 1 to 5 by add IPV. As IPV supply adequate, effective competition and government bargaining power increase, only use IPV or Com-IPV will be economic.Before make national poliovirus vaccine immunization strategy, two questions we have to answer. First, whether or not introduce IPV into NIP base on sufficiently evaluate the risk of poliovirus import and spread. We suggest that government should make a phased program, accroding to province-specific actual situation. Second, which schedule can get the best immunization effectiveness. The 2 does IPV and 2 does OPV sequential schedule is cautious base on IPV immunization effectiveness and ICER of this study.ConclusionsIf we assuming the stragety is economic when ICER for per DALY prevention less than triple per capital GDP in 2014, the break-even price of IPV is 27.2、15.5、10.3、 7.9、14.8、46.2 RMB per dose in strategy 1/2/3/4/5/6 respective. Government purchase IPV by reference price.1 dose IPV sequential schedule ICER is obvious impacted by reduction ratio of VAPP morbidity after 1 dose IPV vaccinated. We suggest that government perform research on serology and protection effect of domestic Sabin-IPV.We suggest that government should make a phased program, accroding to province-specific actual situation. The 2 does IPV and 2 does OPV sequential schedule is cautious base on IPV immunization effectiveness and ICER of this study.