A cost-minimisation analysis: comparison of acellular versus whole-cell hexavalent paediatric vaccination strategies in Argentina
This cost-minimization analysis demonstrates that transitioning Argentina's National Immunization Program to an acellular pertussis (aP) hexavalent vaccination strategy would reduce total societal costs by $8.3 million (8.9%) compared to the current whole-cell (wP) approach, primarily driven by significant savings in adverse event management that outweigh higher vaccine acquisition costs.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of parents around the world take their infants to clinics for a series of shots designed to protect them from serious illnesses like diphtheria, tetanus, and whooping cough. In Argentina, the national health program currently uses a specific type of vaccine for these early years that contains whole-cell components of the bacteria that causes whooping cough. While effective at preventing disease, this older version can sometimes cause stronger reactions in babies, such as high fevers or significant swelling at the injection site. To manage these reactions, doctors often need to provide medication, and parents may need to take time off work to care for their unwell children or visit the hospital. Meanwhile, a newer type of vaccine exists that uses only parts of the bacteria, known as an acellular version. This newer formulation is generally gentler on the body, causing fewer side effects, but it costs more to buy. The question facing health officials is not just which vaccine protects children better, but which approach saves the most money for society as a whole when you count the cost of the vaccine itself, the medical care needed for side effects, and the lost time of working parents.
Researchers in Argentina set out to answer this question by comparing the total financial impact of two different strategies for a six-in-one vaccine that protects against diphtheria, tetanus, whooping cough, hepatitis B, polio, and a bacterial infection called Haemophilus influenzae type b. The first strategy involves using the older, whole-cell vaccine for all infants, while the second strategy switches to the newer, gentler acellular vaccine for everyone. The team built a detailed model using data from babies born between 2021 and 2023, looking at the entire population from full-term infants to those born prematurely. They calculated every dollar spent, including the price of the vaccine doses, the cost of administering them, the medical visits required when a baby has a reaction, and the economic value of the time parents lose when they must stay home to care for a sick child. They treated the health system as a single entity, weighing the upfront cost of buying the more expensive vaccine against the downstream savings from having fewer sick children.
The analysis revealed that switching to the gentler, acellular vaccine would actually cost less for the country overall. Although the price tag for buying the new vaccine is significantly higher, the money saved by avoiding the treatment of side effects is even greater. In the researchers' calculations, the total cost for the entire infant population using the older vaccine would be about 93.2 million US dollars. By contrast, using the newer vaccine would bring that total down to 84.9 million US dollars. This represents a saving of roughly 8.3 million dollars, or nearly 9 percent of the total budget. The key driver of this saving is the reduction in adverse events. With the older vaccine, the cost of managing reactions—such as emergency room visits, hospital stays, and medications—would be more than double the cost seen with the newer vaccine. The higher price of the new vaccine is completely offset by the fact that fewer babies get sick from the shot, meaning fewer trips to the doctor and less time lost from work for their families.
This economic advantage holds true even when looking specifically at the public health sector, which provides care for the vast majority of infants in the country. In this sector, which accounts for 94 percent of all doses given, the switch to the acellular vaccine would save an additional 9.1 million dollars. The benefit is even more pronounced for the most vulnerable group: premature and low-birth-weight infants. For these babies, the cost of managing side effects with the older vaccine is exceptionally high because they are more sensitive to reactions. Switching them to the gentler vaccine reduces their side-effect management costs by nearly 80 percent, offering a massive economic and health benefit to the families who need it most. The researchers tested their findings under different scenarios, such as assuming that more families would get vaccinated or using data that suggested side effects might be even more common than expected. In every case, the conclusion remained the same: the strategy using the gentler vaccine resulted in lower total costs for society.
The study suggests that moving to a universal schedule with the acellular hexavalent vaccine is not only a way to reduce the number of injections an infant receives but also a financially sound decision for the nation. By consolidating two shots into one and choosing the formulation that causes fewer reactions, the health system can avoid the hidden costs of treating side effects and the economic disruption to families. While the upfront purchase price of the new vaccine is higher, the analysis demonstrates that the long-term savings from a healthier, less reactive infant population make it the more economical choice. This finding provides a clear economic argument for health officials to consider updating the national immunization program, ensuring that the most vulnerable children receive the gentlest protection available while keeping the overall cost to the country lower.
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