A Cost-Minimization and Budget Impact Analysis to Evaluate the Introduction of an Acellular Hexavalent Vaccination for Pediatric Population in Dominican Republic

OBJECTIVES: The incorporation of multivalent vaccines in vaccination schedules, provides favorable impact on coverage, vaccination time and number of injections. The substitution of the current whole cell pentavalent vaccine (DTwP-Hib-HepB) + IPV scheme for an acellular hexavalent vaccine (DTaP-IPV-Hib-HepB) represents an opportunity to improve health outcomes with reduced adverse events. This study aims to estimate the economic impact of introducing an acellular hexavalent vaccine in the national immunization program (NIP) in Dominican Republic.

METHODS: A cost-minimization analysis comparing both vaccination schemes was developed including vaccine acquisition, adverse reactions management, logistic operation and activities, and social costs associated with time spent by parents, for a 3-dose and 4-dose (booster dose included) vaccination scenarios. A budget impact analysis assessed the economic impact of the hexavalent vaccine introduction on the NIP budget, assuming a 100% substitution of the pentavalent vaccine + IPV scheme.

RESULTS: In the cost-minimization analysis the hexavalent vaccine produced an increase in total costs of 34.0% and 45.8% for the 3-dose and 4-dose scenarios respectively. This was mainly explained by the vaccine acquisition costs. However, the adverse events, logistic and social costs would be reduced by 51.87%–74.87%, 37.50%–49.23%, and 30.52%–46.60% (3-dose–4-dose) respectively. The budget impact analysis showed an overall budget increase of 34.4% and 42.7% with a 37.5% and 50% reduction in total vaccine doses administered, for the 3-dose and 4-dose scenarios respectively.

CONCLUSIONS: Incorporating a hexavalent vaccine in the Dominican Republic NIP would result in a net increase in spending with a large mitigation from reduced adverse events, logistic and social costs. The opportunity cost of liberating vaccine storage capacity could imply a supply chain optimization to allow the introduction of newer vaccines. The increased spending can be regarded as an investment for overall better health outcomes and modernization of the NIP in Dominican Republic.