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The health economics of cholera: A systematic review

Hsiao A, Hall HA, Mogasale V, Quentin W
Vaccine, doi.org/10.1016/j.vaccine.2018.05.120


Background: Vibrio cholera is a major contributor of diarrheal illness that causes signiﬁcant morbidity and
mortality globally. While there is literature on the health economics of diarrheal illnesses more generally,
few studies have quantiﬁed the cost-of-illness and cost-effectiveness of cholera-speciﬁc prevention and
control interventions. The present systematic review provides a comprehensive overview of the literature
speciﬁc to cholera as it pertains to key health economic measures.

Methods: A systematic review was performed with no date restrictions up through February 2017 in
PubMed, Econlit, Embase, Web of Science, and Cochrane Review to identify relevant health economics
of cholera literature. After removing duplicates, a total of 1993 studies were screened and coded indepen-
dently by two reviewers, resulting in 22 relevant studies. Data on population, methods, and results (cost-
of-illness and cost-effectiveness of vaccination) were compared by country/region. All costs were
adjusted to 2017 USD for comparability.

Results: Costs per cholera case were found to be rather low: <$100 per case in most settings, even when
costs incurred by patients/families and lost productivity are considered. When wider socioeconomic costs
are included, estimated costs are >$1000/case. There is adequate evidence to support the economic value
of vaccination for the prevention and control of cholera when vaccination is targeted at high-incidence
populations and/or areas with high case fatality rates due to cholera. When herd immunity is considered,
vaccination also becomes a cost-effective option for the general population and is comparable in cost-
effectiveness to other routine immunizations.

Conclusions: Cholera vaccination is a viable short-to-medium term option, especially as the upfront costs
of building water, sanitation, and hygiene (WASH) infrastructure are considerably higher for countries
that face a signiﬁcant burden of cholera. While WASH may be the more cost-effective solution in the
long-term when implemented properly, cholera vaccination can still be a feasible, cost-effective strategy.

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