Journal Publications

Background Japanese encephalitis (JE) is endemic in many areas of Asia and recent reports highlight the emergence of JE in new geographic areas. Despite the long-standing availability of vaccines for JE, we have limited information on the economic impact of these vaccines in preventing this potentially devastating disease. Given the extensive experience with JE vaccines in China, we undertook an economic analysis to estimate the cost-effectiveness of JE vaccines when administered under programmatic conditions.
Methods We constructed a decision-analytic model to compare immunization programmes using no JE vaccine, an inactivated JE vaccine and a live-attenuated JE vaccine in Shanghai. Using the health care
system perspective, we calculated cumulative health outcomes and direct costs occurring in each strategy over a 30-year period. We conducted a sensitivity analysis to determine the impact of disease and immunization characteristics on program cost-effectiveness.
Finding Compared With no JE immuization, a programme using the inactivated JE vaccine would prevent 451 JE cases, 113 JE deaths, and 6888 disability adjusted life-years per 100000 persons. In contrast, the live-attenuated JE vaccine would prevent 461 cases, 115 deaths, and 7035 disability adjusted life-years per 100000 persons. Overall, the live-attenuated vaccine strategy resulted in 42% greater net cost saving (USD 579,210) compared with the inactivated vaccine strategy (USD 408,714).
Interpretation Both JE immunization strategies resulted in cost saving compared with no JE immunization. The cost-effectiveness of routine immunization to control JE in China highlights the importance of JE vaccines and supports the consideration of more widespread implementation of JE vaccines in other endemic areas.