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  • Title: Preliminary cost-effectiveness analysis of an AIDS vaccine in Abidjan, Ivory Coast.
    Author: Cowley P.
    Journal: Health Policy; 1993 May; 24(2):145-53. PubMed ID: 10128800.
    Abstract:
    A preliminary assessment was made of the cost-effectiveness of a hypothetical AIDS vaccine in Abidjan, Ivory Coast. A total cost of $20,079 per HIV positive case in the Ivory Coast was projected by estimating the indirect and direct costs of infection. The HIV vaccine was then estimated to increase by $5.28; the costs of a fully immunized child (plus costs of the vaccine). After using this data and taking into account that at least 5% of a cohort of vaccine-eligible infants would become HIV positive at approximately age 26, a cost-benefit analysis was undertaken varying cost, efficacy rates for the hypothetical vaccine and HIV seroprevalence rates in order to indicate at what price per individual dose of vaccine would it stop being cost-beneficial. Furthermore, the basic model was expanded to include vaccinating young adults and the added benefits associated with decreased HIV transmission especially in individuals with high risk behavior. The model was expanded to examine the effects of a changing discount rate. Because of the tremendous economic burden due to AIDS, the prospective vaccine costs at which there is no economic benefit were higher than expected. Progress has been made in developing a vaccine against AIDS, but will developing countries be able to afford a vaccine if and when one is developed? Contemplating this question, the author conducted a preliminary assessment of the cost-effectiveness of a hypothetical AIDS vaccine in Abidjan, Ivory Coast. It is projected that the direct and indirect costs of infection per HIV-positive case in the Ivory Coast will total $20,079, and that the HIV vaccine will increase in cost by an estimated $5.28; the cost to fully immunize a child. Full immunity will be conferred after 2 doses of vaccine. Data were used with the allowance that at least 5% of a vaccine-eligible cohort of infants would become HIV-positive at approximately age 26. The cost-benefit analysis varied cost, efficacy rates for the hypothetical vaccine, and HIV seroprevalence rates to determine the price per individual dose of vaccine at which immunization would cease being cost-effective. The basic model was also expanded to include vaccinating young adults and the added benefits associated with decreased HIV transmission especially in individuals with high risk behavior. Moreover, the effects of a changing discount rate were considered along with some of the problems with AIDS vaccine modeling. Final analysis assuming a valid baseline EPI model of 5% HIV seroprevalence rate and a 60% vaccine efficacy rate, found costs to equal benefits at $462/dose; including the dynamic benefits, the price rises to $1287/dose. AIDS, however, imposes an enormous economic burden upon individuals, households, communities, and countries. It may therefore be concluded that a vaccine should be made available to all individuals despite their relative poverty or the relative expense of its provision. An effective vaccine against AIDS would be cost-beneficial in almost any circumstance.
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