Elsevier

Vaccine

Volume 29, Issue 33, 26 July 2011, Pages 5474-5480
Vaccine

Costs and impact of meningitis epidemics for the public health system in Burkina Faso

https://doi.org/10.1016/j.vaccine.2011.05.058Get rights and content

Abstract

Background

Epidemic meningococcal meningitis remains a serious health threat in the African meningitis belt. New meningococcal conjugate vaccines are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics.

Methods

We evaluated the cost and impacts to the public health system of the 2007 epidemic bacterial meningitis season in Burkina Faso through a survey at the different level of the health system. A micro-economic approach was used to evaluate direct medical and non medical costs for both the public health system and households, as well as indirect costs for households.

Results

The total national cost was 9.4 million US$ (0.69 US$ per capita). Health system costs were 7.1 million US$ (1.97% of annual national health spending), with 85.6% for reactive vaccination campaigns. The remaining 2.3 million US$ was borne by households of meningitis cases. The mean cost per person vaccinated was 1.45 US$; the mean cost of case management per meningitis case was 116.3 US$ when including household costs and 26.4 US$ when including only health sector costs. Meningitis epidemics disrupted all health services from national to operational levels with the main contributor being a large increase in medical consultations.

Conclusions

Preventive meningococcal conjugate vaccines should contribute to more efficient use of funds dedicated to meningitis epidemics and limit the disruption of routine health services.

Highlights

► Cost of reactive vaccination campaigns is two times more than for case management. ► Mean cost per person vaccinated is 80 times less than the mean cost of case management per meningitis case. ► Meningitis epidemics disrupt all health services from the national to operational level. ► The main contributor to this disruption is a large increase in health care consultations.

Introduction

Most of the global risk of epidemic Neisseria meningitidis (Nm) meningitis occurs among countries situated in the African meningitis belt, extending from Ethiopia to Senegal [1], [2], which experiences epidemics during the hot, dry, and windy months from December through April. The current strategy to address epidemic meningitis is reactive immunization. While this strategy may prevent some cases, implementation of vaccination only once an epidemic has been declared will not prevent the majority of cases.

New meningococcal conjugate vaccines exist for preventive vaccination. But they are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics. However, there are few reports on the cost of current strategies, including case management and reactive immunization campaigns [3], [4]. This lessens the ability of the international community and national decision-makers to prioritize between different immunization strategies. To address this lack of information, we evaluated the costs and organizational impact of meningitis during the 2006–2007 epidemic season in Burkina Faso.

Section snippets

Study sites and data collection

The study was conducted during the 2006–2007 meningitis epidemic season in two health districts, Réo and Kombissiri. It involved the two associated District Sanitary Regions (DRS), district laboratories (n = 2) and hospitals (MC/S; n = 2), plus a set of health centers (n = 10). At the national level, the study included Ministry of Health (MOH) departments involved in meningitis surveillance and response (n = 8), technical and financial partners (n = 12), and national reference laboratories (n = 2) within

Overview

During the study period (weeks 1–23 of 2007), the Burkina Faso MOH received notification of 25,852 suspected acute bacterial meningitis cases, and 1743 suspected acute bacterial meningitis deaths were documented. The total cost to the country of the meningitis epidemic was 9428 million US$, or 0.69 US$ per capita, one-quarter of which was borne by households and the other three-quarters by the state, the MOH's financial and technical partners (FTP) and the community (Table 2). Household costs

Conclusion

For a low-income country like Burkina Faso [13], the costs of meningitis epidemics to its health system are significant. Equally significant, however, is the disruptive impact of managing meningitis cases vaccination campaigns on the running of the official health system. The Burkinabe health system is already in need of strengthening and also suffers from a global shortage of health workers [14], so the added burden of work associated with the epidemic response places routine health care

Acknowledgements

We acknowledge the United States Agency for International Development (USAID) which funded the research, the Meningitis Vaccine Project (MVP) and the World Health Organization (WHO) which supported the research and the Ministry of Health of Burkina Faso which allowed and facilitated the research.

Authorship: Anaïs Colombini was the Principal Investigator and the Project Manager of the study. She designs the study (protocol, tools, study team), calculates costs, analyses and interprets the data,

References (14)

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