A cost-effectiveness analysis of active compared to passive vaccinovigilance of adverse events following Measles-Rubella vaccine immunization for children in Iganga and Mayuge Districts

Abstract

Introduction: Adverse Events Following Immunization (AEFI) reporting in a mass immunization campaign setting is an important component in ensuring increased acceptability and reduced re-emergencies of diseases. This study assessed the cost-effectiveness of active vaccinovigilance (AVV) compared to passive vaccinovigilance (PVV) for identifying AEFI following Measles-Rubella mass immunization for children aged 9 months to 5 years in Iganga and Mayuge districts. Methods: This was a cost-effectiveness study nested in a cohort that followed up children on day one, 2-3 days, 10 days, and 14 days after vaccination for AEFI. Costs were collected using an ingredients-based approach. Using a specially data abstraction tool data on costs and yield of AEFI cases for PVV and AVV were collected from health facilities and Iganga-Mayuge health demography surveillance site. Cost-effectiveness was assessed as cost per Disability Adjusted Life Years (DALYs) averted and decisions on cost-effectiveness used, and the 2019 Uganda GDP per capita US$794.451 as the threshold. A static decision modeling framework was used to estimate examine the costs and DALYs of alternative strategies from societal perspectives over a one-year time-frame. One-way sensitivity analyses were done to assess the uncertainty of the Incremental Cost-Effectiveness Ratio (ICER) around variations in key variables. Results: AVV yielded 1.56 DALYs compared to the PVV of 33.13 DALYs. The AVV arm averted 31.57 more DALYs, whilst costing USD 574.3 more than the PVV arm with an ICER of USD 18.2 per DALY averted. The AVV remained cost-effective after one sensitivity analyses. The ICER was most sensitive to probability of detecting AEFI due to MR in the active and the probability of detecting severe AEFI of MR in the active strategy. Conclusion: AVV was more cost-effective compared to PVV from the societal perspective. Implementation of AVV is important in realizing better surveillance outcomes in a mass campaign setting.