Combatting the "Forgotten Killer of Children" An Economic Evaluation of the Pneumococcal Conjugate Vaccine (PCV13) for Ghana

Abstract

In 2012, Ghana became one of the first sub-Saharan African nations to receive GAVI support for the introduction a newly developed pneumococcal conjugate vaccine, PCV13. While the introduction has been touted as a success, there has been little formal evaluation of the vaccine: its cost-effectiveness in the Ghanaian context and the success of implementation to date. This thesis attempts to evaluate the appropriateness of the vaccine as a tool to combat childhood pneumonia in Ghana. The primary mode of analysis is a cost-effectiveness analysis of the vaccine for Ghana. However, the thesis also evaluates the sustainability and effectiveness of this intervention and concludes with a brief qualitative comparison with other nations. Based on the results of this cost-effectiveness analysis, PCV13 is a highly cost-effective intervention for Ghana, with an incremental cost-effectiveness ratio of $313.34 per DALY averted. Vaccination would be expected to avert 1,324 deaths and 63,939 cases of pneumonia among the 2007 birth cohort during the first five years of life. These findings are robust to changes in key parameters. Furthermore, the initial implementation appears to have been successful as measured by high coverage, although public health impact has not been observed to date. However, the long-term success of this immunization program hinges upon Ghana's ability to procure funds to finance the program as it graduates from GAVI pricing and to ensure access for all eligible children. Other countries considering introduction of a pneumococcal conjugate vaccine should consider cost-effectiveness, affordability, the strength of their existing EPI program, and the broader political and social context to determine whether the vaccine is an appropriate public health intervention.