{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:32:33Z","timestamp":1760146353799,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Oral cholera vaccination (OCV) campaigns are increasingly used to prevent cholera outbreaks; however, little is known about their cost-effectiveness in refugee camps. We conducted a cost-effectiveness analysis of a pre-emptive OCV campaign in the Maela refugee camp in Thailand, where outbreaks occurred with an annual incidence rate (IR) of up to 10.7 cases per 1000. Data were collected via health sector records and interviews and household interviews. In the base-case scenario comparing the OCV campaign with no campaign, we estimated the campaign effect on the cholera IR and case fatality rate (CFR: 0.09%) from a static cohort model and calculated incremental cost-effectiveness ratios for the outcomes of death, disability-adjusted life-years (DALYs), and cases averted. In sensitivity analyses, we varied the CFR and IR. The household economic cost of illness was USD 21, and the health sector economic cost of illness was USD 51 per case. The OCV campaign economic cost was USD 289,561, 42% attributable to vaccine costs and 58% to service delivery costs. In our base case, the incremental cost was USD 1.9 million per death averted, USD 1745 per case averted, and USD 69,892 per DALY averted. Sensitivity analyses that increased the CFR to 0.35% or the IR to 10.4 cases per 1000 resulted in a cost per DALY of USD 15,666. The low multi-year average CFR and incidence of the cholera outbreaks in the Maela camp were key factors associated with the high cost per DALY averted. However, the sensitivity analyses indicated higher cost-effectiveness in a setting with a higher CFR or cholera incidence, indicating when to consider campaign use to reduce the outbreak risk.<\/jats:p>","DOI":"10.3390\/vaccines12111235","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T12:25:39Z","timestamp":1730291139000},"page":"1235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Costs and Cost-Effectiveness of a Two-Dose Oral Cholera Vaccination Campaign: A Case Study in a Refugee Camp Setting in Thailand"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2264-3229","authenticated-orcid":false,"given":"Aaron S.","family":"Wallace","sequence":"first","affiliation":[{"name":"Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kashmira","family":"Date","sequence":"additional","affiliation":[{"name":"Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah W.","family":"Pallas","sequence":"additional","affiliation":[{"name":"Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuttapong","family":"Wongjindanon","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health, U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina R.","family":"Phares","sequence":"additional","affiliation":[{"name":"Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H16-4, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5514-5037","authenticated-orcid":false,"given":"Taiwo","family":"Abimbola","sequence":"additional","affiliation":[{"name":"Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"ref_1","unstructured":"(2021). Global Trends, Forced Displacement in 2020, UNHCR, The UN Refugee Agency."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1146\/annurev.publhealth.18.1.283","article-title":"The public health aspects of complex emergencies and refugee situations 1","volume":"18","author":"Toole","year":"1997","journal-title":"Annu. Rev. Public Health"},{"key":"ref_3","unstructured":"(2017). World Health Organization, Cholera vaccines: WHO position paper\u2014Recommendations. Vaccine, 34, 477\u2013500."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1001\/jama.279.7.521","article-title":"Treatment and vaccination strategies to control cholera in sub-Saharan refugee settings: A cost-effectiveness analysis","volume":"279","author":"Naficy","year":"1998","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1001\/jama.279.7.552","article-title":"Cholera vaccination in refugee settings","volume":"279","author":"Waldman","year":"1998","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1001\/jama.1992.03480100098039","article-title":"Epidemic cholera in Latin America","volume":"267","author":"Tauxe","year":"1992","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Schaetti, C., Weiss, M.G., Ali, S.M., Chaignat, C.L., Khatib, A.M., Reyburn, R., Tebbens, R.J.D., and Hutubessy, R. (2012). Costs of illness due to cholera, costs of immunization and cost-effectiveness of an oral cholera mass vaccination campaign in Zanzibar. PLoS Neglected Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001844"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.4269\/ajtmh.14-0159","article-title":"Evaluation of targeted mass cholera vaccination strategies in Bangladesh: A demonstration of a new cost-effectiveness calculator","volume":"91","author":"Troeger","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/j.1524-4733.2009.00562.x","article-title":"Cost-Effectiveness of New-Generation Oral Cholera Vaccines: A Multisite Analysis","volume":"12","author":"Jeuland","year":"2009","journal-title":"Value Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4404","DOI":"10.1016\/j.vaccine.2018.05.120","article-title":"The health economics of cholera: A systematic review","volume":"36","author":"Hsiao","year":"2018","journal-title":"Vaccine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ilboudo, P.G., and Le Gargasson, J.-B. (2017). Delivery cost analysis of a reactive mass cholera vaccination campaign: A case study of Shanchol\u2122 vaccine use in Lake Chilwa, Malawi. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2885-8"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1080\/21645515.2018.1460295","article-title":"Feasibility and costs of a targeted cholera vaccination campaign in Ethiopia","volume":"14","author":"Teshome","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.vaccine.2015.10.112","article-title":"Mass vaccination with a two-dose oral cholera vaccine in a long-standing refugee camp, Thailand","volume":"34","author":"Phares","year":"2016","journal-title":"Vaccine"},{"key":"ref_14","unstructured":"World Bank (2024, October 28). World Development Indicators: Official Exchange Rates. Available online: http:\/\/databank.worldbank.org\/data\/reports.aspx?source=2&series=PA.NUS.FCRF&country=."},{"key":"ref_15","unstructured":"World Bank (2024, October 28). Consumer Price Index. Available online: https:\/\/data.worldbank.org\/indicator\/FP.CPI.TOTL?end=2021&locations=TH&start=1960&view=chart."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/S0140-6736(12)61680-8","article-title":"Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010","volume":"380","author":"Salomon","year":"2013","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jamison, D., TBreman, J., Measham, A., Alleyne, G., Claeson, M., and Evans, D. (2006). Disease Control Priorities Project. Disease Control Priorities in Developing Countries, Oxford University Press.","DOI":"10.1596\/978-0-8213-6179-5"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Wang","year":"2016","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S1473-3099(13)70273-1","article-title":"5 year efficacy of a bivalent killed whole-cell oral cholera vaccine in Kolkata, India: A cluster-randomised, double-blind, placebo-controlled trial","volume":"13","author":"Bhattacharya","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sinclair, D., Abba, K., Zaman, K., Qadri, F., and Graves, P.M. (2011). Oral Vaccines for Preventing Cholera, The Cochrane Library.","DOI":"10.1002\/14651858.CD008603.pub2"},{"key":"ref_21","first-page":"29","article-title":"Estimating the willingness to pay for a quality-adjusted life year in Thailand: Does the context of healht gain matter?","volume":"5","author":"Thavorncharoensap","year":"2013","journal-title":"Clin. Outomces Res."},{"key":"ref_22","unstructured":"Revill, P., Ochalek, J., Lomas, J., Nakamura, R., Woods, B., Rollinger, A., Suhrcke, M., Sculpher, M., and Claxton, K. (2024, October 28). Cost-Effectiveness Thresholds: Guiding Health Care Spending for Population Health Improvement; Centre for Health Economics, University of York. November 2015. Available online: http:\/\/www.idsihealth.org\/wp-content\/uploads\/2015\/01\/CE-Thresholds-iDSI-Working-Group-Final-Report.pdf."},{"key":"ref_23","first-page":"120","article-title":"Measuring the benefits of healthcare: DALYs and QALYs\u2014Does the choice of measure matter? A case study of two preventive interventions","volume":"7","author":"Galante","year":"2018","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_24","unstructured":"World Health Organization (2003). Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis, World Health Organization."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S1473-3099(07)70138-X","article-title":"The true burden and risk of cholera: Implications for prevention and control","volume":"7","author":"Zuckerman","year":"2007","journal-title":"Lancet Infect. 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