Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis.
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2023-05
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Abstract
Influenza causes an estimated 3 to 5 million cases of severe illness annually, along with substantial morbidity and mortality, particularly in low- and middle-income countries (LMICs). Currently, Sri Lanka has no influenza vaccination policies and does not offer vaccination within the public healthcare sector. Therefore, we performed a cost-effectiveness analysis of influenza vaccine implementation for the Sri Lankan population. We designed a static Markov model that followed a population cohort of Sri Lankans in three age groups, 0-4, 5-64, and 65+ years, through two potential scenarios: trivalent inactivated vaccination (TIV) and no TIV across twelve-monthly cycles using a governmental perspective at the national level. We also performed probabilistic and one-way sensitivity analyses to identify influential variables and account for uncertainty. The vaccination model arm reduced influenza outcomes by 20,710 cases, 438 hospitalizations, and 20 deaths compared to no vaccination in one year. Universal vaccination became cost-effective at approximately 98.01% of Sri Lanka's 2022 GDP per capita (incremental cost-effectiveness ratio = 874,890.55 Rs/DALY averted; 3624.84 USD/DALY averted). Results were most sensitive to the vaccine coverage in the 5-64-year-old age group, the cost of the influenza vaccine dose in the 5-64-years-old age group, vaccine effectiveness in the under-5-years-old age group, and the vaccine coverage in the under-5-years-old age group. No value for a variable within our estimated ranges resulted in ICERs above Rs. 1,300,000 (USD 5386.15) per DALY adverted. Providing influenza vaccines was considered highly cost-effective compared to no vaccines. However, large-scale national studies with improved data are needed to better inform estimates and determine the impact of vaccination implementation.
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Neighbors, Coralei E, Evan R Myers, Nayani P Weerasinghe, Gaya B Wijayaratne, Champica K Bodinayake, Ajith Nagahawatte, L Gayani Tillekeratne, Christopher W Woods, et al. (2023). Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis. Vaccines, 11(5). p. 932. 10.3390/vaccines11050932 Retrieved from https://hdl.handle.net/10161/29283.
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Scholars@Duke
Coralei Neighbors
Coralei Neighbors is a second-year Ph.D. candidate in Population Health Sciences at Duke University School of Medicine. Her research focuses on the intersection of infectious diseases, health economics, and global health policy. With a strong foundation in epidemiology and disease surveillance, gained through a Bachelor of Science from Baylor University and a Master of Science in Global Health from Duke University, Coralei has experience in tackling global health challenges through a dual lens of scientific inquiry and policy analysis.
Her research encompasses infectious disease surveillance, economic modeling, and policy evaluation. With experience in both national and international settings, she is currently contributing to infectious disease surveillance initiatives and developing models to assess the economic impact and sustainability of vaccines and other health interventions in diverse populations. Coralei's work aims to inform the development of evidence-based policies to improve global health outcomes.
Evan Robert Myers
My research interests are broadly in the application of quantitative methods, especially mathematical modeling and decision analysis, to problems in women's health. Recent and current activities include integration of simulation modeling and systematic reviews to inform decisions surrounding cervical, ovarian, and breast cancer prevention and control, screening for postpartum depression, and management of uterine fibroids. We are also engaged in exploring methods for integrating guidelines development and research prioritization. In addition, I have ongoing collaborations using the tools of decision analysis with faculty in other clinical areas Research is conducted through the Division of Reproductive Sciences in the Department of Obstetrics and Gynecology, the Evidence Synthesis Group in the Duke Clinical Research Institute, and the Duke Cancer Institute. I'm also the course director for CRP 259, "Decision Sciences in Clinical Research", in Duke's Clinical Research Training Program.
Gayani Tillekeratne
Global health
Antimicrobial resistance/ stewardship
Acute respiratory tract infections
Emerging infections/ dengue
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