These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera.
    Author: Murray J, McFarland DA, Waldman RJ.
    Journal: Bull World Health Organ; 1998; 76(4):343-52. PubMed ID: 9803585.
    Abstract:
    Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera. The recent development of safe, reasonably effective oral cholera vaccines has made it possible to consider their use in situations where the risk of epidemic cholera is high. This article reviews the potential cost-effectiveness of the B-subunit killed whole-cell (BS-WC) oral cholera vaccine in both a stable refugee population and a population with endemic cholera. Baseline epidemiologic assumptions were applied to the standard populations to generate the expected morbidity and mortality levels for cholera and simple diarrhea; then, the net costs per case and per death averted by various interventions were calculated. In the population at risk for endemic cholera, the net costs per disability-adjusted life year (DALY) averted are considerably higher since incidence and access to health care are lower. In this population, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking water and sanitation or with treatment of the disease. In the refugee population, the net costs per DALY averted are much lower since attack rates are higher and access to health care facilities is assumed to be 100%. In this population, the cost-effectiveness for vaccination is similar to that of providing safe drinking water and sanitation alone and less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. Ultimately, the relative cost-effectiveness of an oral cholera vaccine will depend not only on its safety, effectiveness, and duration of protection against the El Tor biotype, but also on the feasibility of administering it to high-risk populations.
    [Abstract] [Full Text] [Related] [New Search]