Published: 2022-10-29

Cost effectiveness analysis of typhoid fever vaccination in an endemic district of Kabale, Uganda

Daniel Odulusi


Background: Typhoid fever is a preventable disease that affects the livelihood security of households and communities, accounting for a significant portion of the disease burden in Kabale district. Various preventive programs to control this burden such as curative services and vaccination are being implemented without empirical evidence of the effectiveness of either program in terms of costs and outcomes.

Methodology: The study design is a mixed methods design in which for specific research objectives a cross-sectional survey was carried out in addition to a retrospective costing analysis. The outcome being a cost effectiveness evaluation of vaccination against typhoid with the comparator being no vaccination, expressed as the incremental cost effectiveness ratio.

 Results: Incidence rate of 39.8 per 1000, a case fatality rate of 0.061, and cost of illness of $75.62 for inpatient care and $33.85 for an outpatient case, with an average cost of illness of typhoid fever in Kabale district to be $54.74. In addition, typhoid fever costs Kabale district $217,158.8, of which $119,814.92 could be saved if a typhoid fever vaccination program is carried out, that will avert 2,189 cases of typhoid every year for three years. Vaccination results in 28,428.32 DALYs avoided. The resulting ICER of -6.348 reveals that the vaccination program against typhoid fever is both extremely cheaper and very effective in averting both typhoid cases and costs.

Conclusions: a one-time fixed-post typhoid vaccination campaign in Kabale District, Uganda, was estimated to be a very highly cost-effective intervention from the public sector health care delivery perspective.


Typhoid fever, Endemic, Vaccination

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Typhoid fever. Available at: https://www.medicine Accessed on 18 April 2021.

Soper G. The work of a chronic typhoid germ distributor. J Am Med Assoc. 1907;18:2019-22.

World health organization. Typhoid vaccine. Wkly Epidemol Rec. 2018;93(13):153-72.

Vos T, Allen C, Arora M. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1545-60.

Lukwago L, O-Tipo S, Neil KP, Sodha SV, Mikoleit M, Simington SD, et al. A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009. Clin Infect Dis. 2012;54:1091-9.

Kabwama SN, Bulage L, Nsubuga F. A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January-June 2015. BMC Public Health. 2017;17:23.

World Health Organization. Typhoid vaccines: WHO position paper March 2018. Wkly Epidemiol Rec. Wkly Epidemol Rec. 2018;93(13):153-72.

Bhattacharya SK, Sur D, Ochiai RL, Ganguly NK, Ali M, Manna B, et al. A cluster-randomized effectiveness trial of Vi typhoid vaccine in India. N Engl J Med. 2009;361(4):335-44

Yang H, Wu C, Xie G, Gu Q, Wang B, Wang L, et al. Efficacy trial of Vi polysaccha-ride vaccine against typhoid fever in south-western China. Bull World Health Organ. 2001;79(7):625-31.

Scobie HM, Nilles E, Kama M, Kool JL, Mintz E, Wannemuehler KA, et al. Impactof a targeted typhoid vaccination campaign following cyclone Tomas, Republicof Fiji, 2010. Am J Trop Med Hyg. 2014; 90(6):1031-8.

Tabassum F, Nooruddin S, Habib A, Ali N, Hussain I, Pach A. Programmatic evaluation of a school-based typhoid vaccination campaign: findings of qualitative research. Int J Community Med Public Health. 2021; 8:4273-9.

Mirembe BB, Mazeri S, Callaby R, Nyakarahuka L, Kankya C, Muwonge A. Temporal, spatial and household dynamics of typhoid fever in Kasese district, Uganda. PLoS ONE. 2019;14(4):e0214650.

Riewpaiboon A, Piatti M, Ley B, Deen J, Thriemer K, von Seidlein L, et al. Cost of illness due to typhoid Fever in pemba, zanzibar, East Africa. J Health Popul Nutr. 2014;32(3):377-85.

Cristina C, Walters MS, Wefulae E, Date EA, Swerdlowa DL, Vijayaraghavan M, et al. Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: the case of Kasese district in Uganda. J Health Popul Nutr. 2015

WHO guide for standardization of economic evaluations of immunization programmes. Available at: ttps:// Accessed on 20 October 2021.

Woods B, Revill P, Sculpher M, Claxton K. Country level cost-effectiveness thresholds; initial estimates and the need for further research, value in health. J Int Soc Pharmacoeconom Outcome Res. 2015;19(8): 929-35.

Kim JH, Im J, Parajulee P, Holm M, Cruz Espinoza LM, Poudyal N, et al. A systematic review of typhoid fever occurrence in Africa. Clin Infect Dis. 2016;69(6):S492-8.

Riewpaiboon A, Piatti M, Ley B, Deen J, Thriemer K, von Seidlein L, et al. Cost of illness due to typhoid Fever in Pemba, Zanzibar, East Africa. J Health Popul Nutr. 2014;32(3):377-85.

Poulos C, Riewpaiboon A, Stewart JF. Cost of illness due to typhoid fever in five Asian countries. Trop Med Int Health. 2011;16:314-23.

Typhoid conjugate vaccines. Available at: Accessed on 26 December 2021.

Theresa R, Karthikeyan AS, Kumar D, Cao Y, Kang G, Goldhaber-Fiebert JD, et al. Comparison of strategies for typhoid conjugate vaccine introduction in India: a cost-effectiveness modeling study. J Infect Dis. 2021;224(5):S612-24.

Bhutta ZA. Impact of age and drug resistance on mortality in typhoid fever. Arch Dis Child. 1996;75:214-7.