Health Gains and Financial Protection from Pneumococcal Vaccination and Pneumonia Treatment in Ethiopia: Results from an Extended Cost-Effectiveness Analysis

Abstract

Background: Pneumonia and pneumococcal disease cause a large disease burden in resource-constrained settings. We pursue an extended cost-effectiveness analysis (ECEA) of two fully publicly financed interventions in Ethiopia: pneumococcal vaccination for newborns and pneumonia treatment for under-five children in Ethiopia.

Methods: We apply ECEA methods and estimate the program impact on: (1) government program costs; (2) pneumonia and pneumococcal deaths averted; (3) household expenses related to pneumonia/pneumococcal disease treatment averted; (4) prevention of household medical impoverishment measured by an imputed money-metric value of financial risk protection; and (5) distributional consequences across the wealth strata of the country population. Available epidemiological and cost data from Ethiopia are applied and the two interventions are assessed separately at various incremental coverage levels.

Results: Scaling-up pneumococcal vaccines at around 40% coverage would cost about $11.5 million and avert about 2090 child deaths annually, while a 10% increase of pneumonia treatment to all children under 5 years of age would cost about $13.9 million and avert 2610 deaths annually. Health benefits of the two interventions publicly financed would be concentrated among the bottom income quintile, where 30-40% of all deaths averted would be expected to occur in the poorest quintile. In sum, the two interventions would eliminate a total of $2.4 million of private household expenditures annually, where the richest quintile benefits from around 30% of the total private expenditures averted. The financial risk protection benefits would be largely concentrated among the bottom income quintile. The results are most sensitive to variations in vaccine price, population size, number of deaths due to pneumonia, efficacy of interventions and out-of-pocket copayment share.

Conclusions: Vaccine and treatment interventions for children, as shown with the illustrative examples of pneumococcal vaccine and pneumonia treatment, can bring large health and financial benefits to households in Ethiopia, most particularly among the poorest socio-economic groups.

Fig 1. Summary of the conceptual structure of the methodology of extended cost-effectiveness analysis (ECEA) where we measure the program impact in four domains: (1) health gains; (2) household private expenditures averted; (3) prevention of household medical impoverishment; and (4) distributional consequences across the wealth strata of the country population.

Fig 2. Level and distribution of household expenditures averted, health benefits (deaths averted and severe episodes of pneumococcal pneumoniae averted), and financial risk protection, for scale-up of pneumococcal vaccination and pneumonia treatment provided by universal public finance in Ethiopia.

Fig 3. Expected health benefits (deaths averted) versus financial risk protection afforded (2011 US$), per $1,000,000 spent for universal public finance of pneumococcal vaccination and/or pneumonia treatment scale-up in Ethiopia, where results are shown for 5 income quintiles (I is poorest and V is richest).

Fig 4. Uncertainty analysis for each of the two policies (universal public finance of pneumonia treatment and pneumococcal vaccines) in Ethiopia, key variables are modified as a one-way deterministic sensitivity analyses, (for more detailed results across income quintiles see S2–S4 Tables).