OBJECTIVES : Indonesia, accounted as the country with the third highest burden of tuberculosis (TB) disease, has already implemented Bacillus Calmette-Guerin (BCG) in the national immunization program since 1946. Recently, the Indonesian government issued a national program for controlling TB disease translated into several action plans, inclusive vaccination. The aim of this study is to evaluate the cost-effectiveness of the BCG vaccination program in Indonesia.

METHODS : A Markov model was developed to assess the cost-effectiveness of the current BCG vaccination program in Indonesia compared to no vaccination. A birth cohort in 2017 as initial population and a life time horizon with annual cycle were applied. The incremental cost-effectiveness ratio (ICER) was evaluated from both the societal and health-care perspectives. A universal guideline of 3% discount rate was followed both for the costs and outcomes. The robustness of the analysis was assessed using univariate and probabilistic sensitivity analysis (PSA).

RESULTS : Based on the TB epidemiological data for Indonesian setting, BCG vaccination at a price $14 was a cost-effective strategy in controlling TB disease. With a total vaccination cost around $57 millions for single birth cohort, the total QALYs-gained was 497.207 - resulted an ICER of $102,63 and $110,03/QALY from the societal and health-care perspectives, respectively. The findings were robust to variations for most variables in univariate analysis; vaccine effectiveness for disease protection, vaccination costs, and case detection rates were most influential. The PSA showed that vaccination was deemed cost-effective at one GDP per capita ($3.847) and even 95% cost-effective at $175, which is similar to a monthly GDP per capita.

CONCLUSIONS : Using a static model with conservative assumptions, BCG vaccination was found a cost-effective strategy for Indonesia. The findings suggest that the strategy deserves to be prioritized in the national TB program and results may indicative for other high endemic low/middle income countries.