INCORPORATING EQUITY INTO VACCINE DECISION-MAKING IN BRAZIL: A DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS OF MATERNAL RESPIRATORY SYNCYTIAL VIRUS IMMUNIZATION
Author(s)
Erick Polli1, Sophia Borges, MD-PhD2, NATACHA CERCHIARI, MSc, MD3, Ana Carolina Nonato, MSc, MD4, Ana Marli Sartori, PhD5, Patricia de Soarez, MPH, MSc, PhD6.
1FMUSP, Brazil, 2Faculdade de Medicina da Universidade de Sao Paulo FMUSP, São Paulo, Brazil, 3FMUSP, SAO PAULO, Brazil, 4Universidade de São Paulo, São Paulo, Brazil, 5FMUSP, São Paulo, Brazil, 6Universidade de Sao Paulo, n/a, Brazil.
1FMUSP, Brazil, 2Faculdade de Medicina da Universidade de Sao Paulo FMUSP, São Paulo, Brazil, 3FMUSP, SAO PAULO, Brazil, 4Universidade de São Paulo, São Paulo, Brazil, 5FMUSP, São Paulo, Brazil, 6Universidade de Sao Paulo, n/a, Brazil.
OBJECTIVES: Brazil is one of the most unequal countries in the world, which is reflected in the distribution of health. Therefore, is important to analyze how the benefits of a health intervention are distributed. We apply the Distributional Cost-Effectiveness Analysis (DCEA) to evaluate how the maternal Respiratory Syncytial Virus (RSV) vaccine affects the distribution of health benefits and costs through Brazilian health macro-regions.
METHODS: A DCEA was applied at the Brazilian health macro-region level for a birth cohort during the first year of life, using data from 2023. The strategies compared were universal maternal vaccination (MV) with RSVPreF vs. no MV. We estimated a baseline distribution of HALE before the MV was implemented and how it changed after the intervention. Opportunity costs were estimated considering the incremental costs divided by the Cost-Effectiveness Threshold (CET) for Brazil (US$ 8016). The opportunity costs were distributed considering the size of the population in each health macro-region. Net health benefits were estimated as DALYs averted with the MV, minus the opportunity costs of the MV. We also analyzed possible trade-offs between cost-effectiveness and equity. Sensitivity analysis was conducted to explore changes in prices and distribution of opportunity costs.
RESULTS: Maternal RSV vaccine is cost-effective only in four of the 121 macro-regions, which means that the intervention results in a negative health benefit in 117 macro-regions, and the loss of 4481 DALYs averted. The loss in net health is well distributed along the macro-regions, and the intervention slightly improves the distribution of health. The improvement in the distribution is not enough to compensate for loss in net health benefit, which means that no matter how big the aversion to inequality is, the intervention would not be chosen.
CONCLUSIONS: The intervention has a negative health benefit, and the distribution of health benefits has slight improvement in Brazilian health macro regions.
METHODS: A DCEA was applied at the Brazilian health macro-region level for a birth cohort during the first year of life, using data from 2023. The strategies compared were universal maternal vaccination (MV) with RSVPreF vs. no MV. We estimated a baseline distribution of HALE before the MV was implemented and how it changed after the intervention. Opportunity costs were estimated considering the incremental costs divided by the Cost-Effectiveness Threshold (CET) for Brazil (US$ 8016). The opportunity costs were distributed considering the size of the population in each health macro-region. Net health benefits were estimated as DALYs averted with the MV, minus the opportunity costs of the MV. We also analyzed possible trade-offs between cost-effectiveness and equity. Sensitivity analysis was conducted to explore changes in prices and distribution of opportunity costs.
RESULTS: Maternal RSV vaccine is cost-effective only in four of the 121 macro-regions, which means that the intervention results in a negative health benefit in 117 macro-regions, and the loss of 4481 DALYs averted. The loss in net health is well distributed along the macro-regions, and the intervention slightly improves the distribution of health. The improvement in the distribution is not enough to compensate for loss in net health benefit, which means that no matter how big the aversion to inequality is, the intervention would not be chosen.
CONCLUSIONS: The intervention has a negative health benefit, and the distribution of health benefits has slight improvement in Brazilian health macro regions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE442
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Topic Subcategory
Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Pediatrics, Vaccines