OBJECTIVES

: Bacillus Calmette-Guerin (BCG) is the only licensed vaccine for tuberculosis. However its effectiveness is shown to be variable depending on age of the recipient and the geographical settings. A valid cost effectiveness study is needed to help decision makers implementing the most cost-effective strategy for BCG vaccination. The aim of this study is to systematically review the outcomes of the pharmacoeconomic studies of BCG vaccination and assess the quality and consistency of the study results.

METHODS

: We comprehensively searched PUBMED and EMBASE. We included studies that performed economic evaluation on BCG vaccination and were written in English. We used the Quality of Health Economic Studies(QHES) instrument to assess the quality of the included studies.

RESULTS

: Twenty-one articles were included in the review. There was a high level of heterogeneity of applying BCG-vaccine within the studies regarding specific strategies followed, participants, type of vaccines, comparators, and study designs. Thirteen studies evaluated universal strategy, six studies evaluated targeted or otherwise specific strategies, and the remaining articles assessed revaccination strategies. Most of the studies evaluated licensed BCG-vaccines in the market while four articles assessed the effectiveness of hypothetical vaccines. The quality of the studies varied, but the majority were of high to satisfactory quality. However, not all studies used optimal sources for the input parameters. Additionally, the potential of bias, probably interfering with the results, was rarely discussed.

CONCLUSIONS

: Most of the studies showed a favorable economic profile of BCG vaccination. A selective strategy seems most cost effective to be applied in low incidence areas. Varying results on revaccination strategies could not lead to a conclusive finding on the cost effectiveness of BCG vaccination. Future economic evaluations should better consider optimal sources for input parameters and cover the issue of potential bias in results.