ArticleVaccine2018
Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option.
Article in Vaccine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Inclusion of Additional Unintended Consequences in Economic Evaluation: A Systematic Review of Immunization and Tuberculosis Cost-Effectiveness Analyses.PharmacoEconomics - open · 2021Pooled it
- Economic Evaluation of Pneumococcal Vaccination in Egypt: Cost-Effectiveness, Budget Impact, and Domestic Manufacturing Potential.Vaccines · 2026Article
- Cost-Effectiveness of Infant Pneumococcal Conjugate Vaccination Strategies in Vietnam: A Stepwise Economic Evaluation.Vaccines · 2026Article
- Cost-effectiveness of a 13-valent pneumococcal conjugate vaccine compared with currently available pneumococcal conjugate vaccines in Indian children.IJID regions · 2025Article
- Valuing health across groups: a cross-sectional population-based willingness-to-pay survey in Bhutan.BMJ global health · 2025Article
- Advancing evidence-based decision-making in Bhutan: development of a health technology assessment framework.The Lancet regional health. Southeast Asia · 2024Review
- Cost-Effectiveness Analysis of Pneumococcal Vaccines in the Pediatric Population: A Systematic Review.Healthcare (Basel, Switzerland) · 2024Review
- Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies.Public health challenges · 2024Article
- Framework for developing cost-effectiveness analysis threshold: the case of Egypt.The Journal of the Egyptian Public Health Association · 2024Article
- Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis.Scientific reports · 2021Article
- Bhutan's experience with COVID-19 vaccination in 2021.BMJ global health · 2021Article
- Evidence gaps in economic analyses of hearing healthcare: A systematic review.EClinicalMedicine · 2021Article
- Epidemiology, Nasopharyngeal Carriage, Serotype Prevalence, and Antibiotic Resistance of Streptococcus pneumoniae in Indonesia.Infectious diseases and therapy · 2020Review
- Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates.PharmacoEconomics · 2020Article
- Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies.Vaccines · 2020Review
- Article
- Pneumonia in Bhutanese children: what we know, and what we need to know.Pneumonia (Nathan Qld.) · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDue to competing health priorities and limited resources, many low-income countries, even those with a high disease burden, are not able to introduce pneumococcal conjugate vaccines.
objectiveTo determine the cost-utility of 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan.
methodsA model-based cost-utility analysis was performed in the Bhutanese context using a government perspective. A Markov simulation model with one-year cycle length was used to estimate the costs and outcomes of three options: PCV10, PCV13 and no PCV programmes for a lifetime horizon. A discount rate of 3% per annum was applied. Results are presented using an incremental cost-effectiveness ratio (ICER) in United State Dollar per quality-adjusted life year (QALY) gained (USD 1 = Ngultrum 65). A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty.
resultsCompared to no vaccination, PCV10 and PCV13 gained 0.0006 and 0.0007 QALYs with additional lifetime costs of USD 0.02 and USD 0.03 per person, respectively. PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained compared to no vaccination. In addition, PCV13 produced an ICER of USD 92 compared with PCV10. When including PCV into the Expanded Programme on Immunization, the total 5-year budgetary requirement is anticipated to increase to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6-1.1 FTE) and nurse (1-1.6 FTE).
conclusionAt the suggested threshold of 1xGDP per capita equivalent to USD 2708, both PCVs are cost-effective in Bhutan and we recommend that they be included in the routine immunization programme.
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Registered trials
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