Evidence map›Paper›PMID 34344667›Full record

ArticleBMJ global health2021

Disregarding the restrictive vial-opening policy for BCG vaccine in Guinea-Bissau: impact and cost-effectiveness for tuberculosis mortality and all-cause mortality in children aged 0-4 years.

Sanne M Thysen, Ane Baerent Fisker, Stine Byberg, Peter Aaby, Partho Roy, Richard White, Ulla Griffiths, Rebecca C Harris

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
1.1field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 19 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Trial
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 4 countries.

Sanne M ThysenOPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark s.thysen@bandim.org.ORCID 0000-0003-4541-3901
Ane Baerent FiskerOPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.ORCID 0000-0002-8521-0992
Stine BybergBandim Health Project, Bissau, Guinea-Bissau.
Peter AabyBandim Health Project, Bissau, Guinea-Bissau.
Partho RoyTB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
Richard WhiteTB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
Ulla GriffithsHealth section, UNICEF, New York, New York, USA.
Rebecca C HarrisTB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
Statens Serum Institut · DKLondon School of Hygiene & Tropical Medicine · GBUnited Nations Children's Fund · US

Funding

Defining drivers of TB transmission in the era of universal ART, and implications for finding the walking wellR01AI147321 · NIAID · LONDON SCH/HYGIENE & TROPICAL MEDICINE · PI GRANT, ALISON · 2019 to 2024
$2.3M
Gates Foundation INV-001754Medical Research Council CCF17-7779Medical Research Council MR/P002404/1NIAID NIH HHS R01 AI147321Wellcome TrustWellcome Trust 218261/Z/19/Z
6 · The paper itself

Abstract

objectiveBCG vaccination is frequently delayed in low-income countries. Restrictive vial-opening policies, where a vial of BCG vaccine is not opened for few children, are a major reason for delay. During delays, children are unprotected against tuberculosis (TB) and deprived of non-specific effects of BCG. We assessed the potential effect and cost-effectiveness of disregarding the restrictive vial-opening policy, on TB and all-cause mortality, in children aged 0-4 years in Guinea-Bissau.

methodsUsing static mathematical models, we estimated the absolute and percentage change in TB and all-cause deaths, in children aged 0-4 years, between the current BCG vaccine restrictive-opening policy scenario, and a non-restrictive policy scenario where all children were vaccinated in the first health-facility contact. Incremental cost-effectiveness was estimated by integration of vaccine and treatment costs.

findingsDisregarding the restrictive BCG vial-opening policy was estimated to reduce TB deaths by 11.0% (95% uncertainty range (UR):0.5%-28.8%), corresponding to 4 (UR:0-15) TB deaths averted per birth cohort in Guinea-Bissau, resulting in incremental cost-effectiveness of US$ 911 per discounted life-year gained (LYG) (UR:145-9142). For all-cause deaths, the estimated reduction was 8.1% (UR: 3.3%-12.7%) corresponding to 392 (UR:158-624) fewer all-cause deaths and an incremental cost-effectiveness of US$ 9 (UR:5-23) per discounted LYG.

conclusionsDisregarding the restrictive BCG vial-opening policy was associated with reductions in TB deaths and all-cause deaths and low cost-effectiveness ratios. Our results suggest that it would be cost-effective to disregard the restrictive vial-opening policy. Other settings with similar practice are also likely to gain from disregarding this policy.

Indexed as

BCG VaccineTuberculosisChildCost-Benefit AnalysisGuinea-BissauHumansPolicyBCG Vaccinechild healthepidemiologypaediatricspublic healthtuberculosis

Identifiers

PMID34344667
PMCPMC8336130
OpenAlexW3188536389

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.