For the vaccine recipients
Childhood immunization is one of the most cost-effective public health interventions to reduce children’s morbidity and mortality. Improving vaccination compliance is critical to maximizing vaccine effectiveness and preventing large-scale outbreaks of infectious diseases. Several early studies have shown that pediatric combination vaccines (particularly those containing pertussis, diphtheria, tetanus, and Haemophilus influenzae type b antigens) can not only help improve vaccination compliance but also increase vaccination timeliness and reduce the number of children who are not immunized on time, compared with using the traditional monovalent vaccines1,2,3.
Other studies have questioned the sayings that combination vaccines may increase the health risk for the vaccine recipients. The total number of adverse events caused by the three monovalent vaccines for pertussis, diphtheria, and tetanus exceeds those caused by the three-in-one combination vaccine, suggesting that the DTP combination vaccines may reduce the incidence of potential adverse events4.
In addition, the injection pain experienced by children has always been a concern for vaccine recipients, caregivers, and healthcare workers. Several studies have shown that combination vaccines reduced the number of vaccinations, alleviating infants’ fears and helping children avoid additional pain and discomfort5,6,7,8.
For the caregivers
Combination vaccines can also benefit caregivers. A cross-sectional study conducted nationwide in China used cost-minimization analysis (CMA) to measure the direct medical, direct non-medical cost (transportation expenditure incurred by caregivers), and indirect social cost (loss of working time) associated with the DTaP-IPV-Hib pentavalent vaccine. The results showed that the DTaP-IPV-Hib pentavalent vaccine replaced the NIP vaccine schedule in China. However, direct medical costs would increase, both direct non-medical and indirect social costs would decrease. Overall, introducing the DTaP-IPV-Hib pentavalent vaccine in China would reduce costs9. Another study from the United States observed that introducing pediatric combination vaccines could significantly save caregivers’ time and energy10.
Some researchers have found that combination vaccines, by reducing pain for recipients and saving multiple costs, increased the caregivers’ acceptance and willingness to pay for these vaccines11. On average, caregivers are willing to pay an additional US$10 to US$ 25 to reduce the doses received 12.
For the healthcare workers
It takes 1.7 to 2.4 minutes for a nurse to complete the administration of one dose of vaccine for a child. The child will also cry for 0.4 to 1 minute longer due to discomfort and fear13,14. By using combination vaccines to reduce the number of injections, the workload of healthcare workers will be significantly reduced, improving work efficiency. Another study has pointed out that by requiring fewer syringes, the use of combination vaccines can effectively reduce the risk of needle-stick injuries and other human errors among healthcare workers15,16.
For the public health system
Combination vaccines can bring tremendous improvements to the national health system. The most obvious advantage is the reduced expenditure on health systems, including logistics, warehouse, operational management, and human resource costs18,17,18,19.
Existing evidence has shown that the use of combination vaccines can also help increase vaccine coverage and mitigate the burden of disease20,21,22. An early study from the United States indicated that if the hepatitis B vaccine is included in the combination vaccine, the number of hepatitis B virus infection cases can be reduced by 53%. At the same time, 205 hepatitis B virus-related deaths will be reverted per 1 million infants. This strategy’s incremental cost-effectiveness ratio (ICER) is US$ 17,700 per life-year saved23. A panel data analysis conducted in multiple countries showed that developing combination vaccines containing additional antigens can help maintain and improve the coverage of existing and new childhood vaccines. After introducing the combination vaccine, the coverage of pertussis, diphtheria, and tetanus triple vaccine increased by about 3% worldwide24.
In addition, the use of combination vaccines for children will also help optimize the immunization program25, 26, 27. For example, when combination vaccines such as the hexavalent vaccine were included in the French national immunization program, the total number of doses that should be administered was reduced from21 to 10. The use of combination vaccines will help coordinate resources, reduce management costs, and improve the efficiency of immunization programs.
According to China’s national immunization program (NIP), excluding the one dose of BCG vaccine and one dose of hepatitis B vaccine given at birth, children under 2 years old need to receive 15 doses of NIP vaccines; there are also 16 doses of non-NIP vaccines, including the 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13), Haemophilus influenzae type b vaccine (Hib), rotavirus vaccine, influenza vaccine, varicella vaccine, EV71 vaccine, etc., which are optional for vaccination28. For children under 2 years old, China has not yet introduced three vaccines recommended by WHO (Hib vaccine, PCV vaccine, rotavirus vaccine). However, the total vaccination doses received under 2 years old exceed those received in the United States, where only 12 doses are administered for the same age group. If the above three vaccines are included, excluding the birth dose vaccine, children under 2 years old in China must receive at least 27 doses. Therefore, the introduction of combination vaccines is conducive to reducing the doses children receive and optimizing the immunization program. Some researchers have made more specific estimates that the cost of adding a dose of Haemophilus influenzae type b vaccine to the vaccination program as part of the pentavalent vaccine antigen component (DTP-HepB-Hib) is US$2.80, as part of the quadruple vaccine antigen component (DTP-Hib) is US$3.10, and if it is provided as a traditional monovalent vaccine, the cost is US$ 3.40 15 .
From R&D institutions
From the perspective of R&D institutions, compared with traditional monovalent vaccines, combination vaccines can help vaccine manufacturers reduce R&D-related costs29 and motivate them to advance their innovation20. According to the conclusions drawn from existing evidence, the cost-effectiveness of developing combination vaccines is higher than that of monovalent vaccines, and the cost of producing vaccines with higher valent is lower than that of developing vaccines with a lower valent combination.
Content editor: Siqi Jin
Page editor: Ziqi Liu
References
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