COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.

<h4>Background</h4>Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines...

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Autores principales:	Carl A B Pearson, Fiammetta Bozzani, Simon R Procter, Nicholas G Davies, Maryam Huda, Henning Tarp Jensen, Marcus Keogh-Brown, Muhammad Khalid, Sedona Sweeney, Sergio Torres-Rueda, CHiL COVID-19 Working Group, CMMID COVID-19 Working Group, Rosalind M Eggo, Anna Vassall, Mark Jit
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/5483efc8283b4575ac5bc7800eb4b403
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id	oai:doaj.org-article:5483efc8283b4575ac5bc7800eb4b403
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Carl A B Pearson Fiammetta Bozzani Simon R Procter Nicholas G Davies Maryam Huda Henning Tarp Jensen Marcus Keogh-Brown Muhammad Khalid Sedona Sweeney Sergio Torres-Rueda CHiL COVID-19 Working Group CMMID COVID-19 Working Group Rosalind M Eggo Anna Vassall Mark Jit COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
description	<h4>Background</h4>Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million).<h4>Methods and findings</h4>We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question.<h4>Conclusions</h4>COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.
format	article
author	Carl A B Pearson Fiammetta Bozzani Simon R Procter Nicholas G Davies Maryam Huda Henning Tarp Jensen Marcus Keogh-Brown Muhammad Khalid Sedona Sweeney Sergio Torres-Rueda CHiL COVID-19 Working Group CMMID COVID-19 Working Group Rosalind M Eggo Anna Vassall Mark Jit
author_facet	Carl A B Pearson Fiammetta Bozzani Simon R Procter Nicholas G Davies Maryam Huda Henning Tarp Jensen Marcus Keogh-Brown Muhammad Khalid Sedona Sweeney Sergio Torres-Rueda CHiL COVID-19 Working Group CMMID COVID-19 Working Group Rosalind M Eggo Anna Vassall Mark Jit
author_sort	Carl A B Pearson
title	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
title_short	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
title_full	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
title_fullStr	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
title_full_unstemmed	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.
title_sort	covid-19 vaccination in sindh province, pakistan: a modelling study of health impact and cost-effectiveness.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/5483efc8283b4575ac5bc7800eb4b403
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spelling	oai:doaj.org-article:5483efc8283b4575ac5bc7800eb4b4032021-12-02T19:55:44ZCOVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.1549-12771549-167610.1371/journal.pmed.1003815https://doaj.org/article/5483efc8283b4575ac5bc7800eb4b4032021-10-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003815https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million).<h4>Methods and findings</h4>We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question.<h4>Conclusions</h4>COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.Carl A B PearsonFiammetta BozzaniSimon R ProcterNicholas G DaviesMaryam HudaHenning Tarp JensenMarcus Keogh-BrownMuhammad KhalidSedona SweeneySergio Torres-RuedaCHiL COVID-19 Working GroupCMMID COVID-19 Working GroupRosalind M EggoAnna VassallMark JitPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 10, p e1003815 (2021)

COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.

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