{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:42:50Z","timestamp":1767858170959,"version":"3.49.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,24]],"date-time":"2022-01-24T00:00:00Z","timestamp":1642982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","award":["NMRR-17-471-34944"],"award-info":[{"award-number":["NMRR-17-471-34944"]}],"id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The potential occurrence of disease outbreaks during the hajj season is of great concern due to extreme congestion in a confined space. This promotes the acquisition, spread and transmission of pathogenic microorganisms and pneumococcal disease are one of the most frequent infections among Hajj pilgrims. This study aimed to assess the cost-effectiveness and budget impact of introducing the PPV23 to Malaysian Hajj pilgrims. A decision tree framework with a 1-year cycle length was adapted to evaluate the cost-effectiveness of a PPV23 vaccination program with no vaccination. The cost information was retrieved from the Lembaga Tabung Haji Malaysia (LTH) database. Vaccine effectiveness was based on the locally published data and the disease incidence specifically related to <jats:italic>Streptococcus pneumoniae<\/jats:italic> was based on a literature search. Analyses were conducted from the perspective of the provider: Ministry of Health and LTH Malaysia. The incremental cost-effectiveness ratios (ICER), cases averted, and net cost savings were estimated. Findings from this study showed that PPV23 vaccination for Malaysian Hajj pilgrims was cost-effective. The PPV23 vaccination programme has an ICER of MYR -449.3 (US$-110.95) per case averted. Based on the national threshold value of US$6,200-US$8,900 per capita, the base-case result shows that introduction of the PPV23 vaccine for Malaysian Hajj pilgrims is very cost-effective. Sensitivity analysis revealed parameters related to annual incidence and hospitalised cost of septicemia and disease without vaccination as the key drivers of the model outputs. Compared with no vaccination, the inclusion of PPV23 vaccination for Malaysian Hajj pilgrims was projected to result in a net cost saving of MYR59.6 million and 109,996 cases averted over 5 years period. The PPV23 vaccination program could substantially offer additional benefits in reducing the pneumococcal disease burden and healthcare cost. This could be of help for policymakers to consider the implementation of PPV23 vaccination for Malaysian performing hajj.<\/jats:p>","DOI":"10.1371\/journal.pone.0262949","type":"journal-article","created":{"date-parts":[[2022,1,24]],"date-time":"2022-01-24T18:25:43Z","timestamp":1643048743000},"page":"e0262949","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness and budget impact analysis of PPV23 vaccination for the Malaysian Hajj pilgrims"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-5017","authenticated-orcid":true,"given":"Farhana","family":"Aminuddin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Amalina","family":"Zaimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Shaiful Jefri","family":"Mohd Nor Sham Kunusagaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Shahri","family":"Bahari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nor Zam Azihan","family":"Mohd Hassan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,1,24]]},"reference":[{"issue":"9934","key":"pone.0262949.ref001","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/S0140-6736(14)60381-0","article-title":"Hajj: infectious disease surveillance and control","volume":"383","author":"ZA Memish","year":"2014","journal-title":"Lancet"},{"key":"pone.0262949.ref002","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ijid.2018.02.008","article-title":"Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016","volume":"69","author":"A AlBarrak","year":"2018","journal-title":"Int J Infect Dis"},{"issue":"3","key":"pone.0262949.ref003","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jiph.2016.04.016","article-title":"Mass gathering medicine (Hajj Pilgrimage in Saudi Arabia): The clinical pattern of pneumonia among pilgrims during Hajj","volume":"10","author":"BH Shirah","year":"2017","journal-title":"J Infect Public Health"},{"issue":"2","key":"pone.0262949.ref004","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1080\/21645515.2015.1058456","article-title":"Prevention of pneumococcal infections during mass gathering","volume":"12","author":"JA Al-Tawfiq","year":"2016","journal-title":"Hum Vaccin Immunother"},{"issue":"1","key":"pone.0262949.ref005","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1471-2334-12-117","article-title":"Clinical and temporal patterns of severe pneumonia causing critical illness during Hajj","volume":"12","author":"Y Mandourah","year":"2012","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pone.0262949.ref006","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-0029-1202938","article-title":"Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention","volume":"30","author":"JP Lynch","year":"2009","journal-title":"Semin Respir Crit Care Med"},{"issue":"2","key":"pone.0262949.ref007","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0924-8579(01)00491-5","article-title":"The burden of invasive pneumococcal disease and the potential for reduction by immunisation","volume":"19","author":"HK Parsons","year":"2002","journal-title":"Int J Antimicrob Agents"},{"issue":"5955","key":"pone.0262949.ref008","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1126\/science.1183210","article-title":"Public health. 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