Economic Evaluation on Pentavalent Vaccine Versus Hexavalent Vaccine in Childhood Immunization Programs: A Systematic Review
Keywords:
HEXAVALENT, pentavalent, Economic evaluation, Cost-minimisation, Childhood immunisationAbstract
|
Background: The childhood immunisation programme is a key pillar in the prevention of infectious diseases. The hexavalent vaccine, which combines six antigens (DTPa-HepB-IPV-Hib) in a single formulation, offers a practical alternative to pentavalent vaccines used in combination with separate hepatitis B and polio vaccines. This study aims to evaluate and compare the economic aspects of pentavalent and hexavalent vaccines across various forms of economic evaluation to support the sustainability of childhood immunisation programmes. Method: This systematic review was conducted following PRISMA 2020 guidelines using the PICO framework. Articles were retrieved from PubMed, ScienceDirect, and EBSCO databases using MeSH-based keywords. Inclusion criteria covered articles published within the last five years comparing hexavalent and pentavalent vaccines in childhood immunisation programmes for children aged 0–2 years. Study quality was assessed using Drummond's 10-item checklist. Results: Six studies from Colombia, Peru, Argentina, Chile, South Korea, and China were analysed. All studies assumed comparable clinical efficacy between vaccines and applied the cost-minimisation analysis (CMA) approach. From both health system and societal perspectives, the hexavalent vaccine consistently demonstrated lower total costs per fully immunised child (FIC). Key efficiency drivers included a reduction in injections, fewer health facility visits, reduced adverse events, and improved healthcare worker efficiency. Results remained robust across sensitivity analyses conducted in all models. Conclusion: Although more expensive per dose, the hexavalent vaccine proved more efficient and cost-effective in childhood immunisation programmes, especially in settings with logistical constraints. These findings support the integration of the hexavalent vaccine into national immunisation policies. |
Downloads
References
Aljunid, S. M., Al Bashir, L., Ismail, A. B., Aizuddin, A. N., Rashid, S. A. Z. A., & Nur, A. M. (2022). Economic impact of switching from partially combined vaccine “Pentaxim® and hepatitis B” to fully combined vaccine “Hexaxim®” in the Malaysian National Immunization Program. BMC Health Services Research, 22(1), 1–12. https://doi.org/10.1186/s12913-021-07428-7
Awaidy, S. T., Gebremeskel, B. G., Al Obeidani, I., Al Baqlani, S., Haddadin, W., & O’Brien, M. A. (2014). Cost effectiveness of a pentavalent rotavirus vaccine in Oman. BMC Infectious Diseases, 14(1), 12–14. https://doi.org/10.1186/1471-2334-14-334
Centers for Disease Control and Prevention. (2020). Combination vaccines. https://www.cdc.gov/vaccines/vpd/combo-vaccines.html
Dakin, A., Borrow, R., & Arkwright, P. D. (2023). A review of the DTaP-IPV-HB-PRP-T Hexavalent vaccine in pediatric patients. Expert Review of Vaccines, 22(1), 104–117. https://doi.org/10.1080/14760584.2023.2161519
Dewi, D. S., & Nadjib, M. (2022). Systematic Review: Analisis Efektivitas Biaya Vaksin Pneumococcal Conjugate Vaccine (Pcv). Jurnal Medika HUtama, 03(03), 2593–2600. https://www.jurnalmedikahutama.com/index.php/JMH/article/view/488
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods forthe economic evaluation of health care programmes. Oxford university press
Guerra, A., Costantino, C., Martinon-Torres, F., Westerholt, S., Lambeth, C., Chen, Z., Lumley, J., Marcek, T., Johnson, D., & Wilck, M. (2024). A phase 4, open-label study to evaluate the safety and immunogenicity of DTaP5-HBV-IPV-Hib in children previously vaccinated with DTaP2-HBV-IPV-Hib or DTaP5-HBV-IPV-Hib (V419-016). Human Vaccines and Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2310900
Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230
Huang, A., Xu, X., Tang, L., Huang, L., Li, J., Zhang, X., Liu, J., Zhou, Y., Zhang, B., Wang, L., Zhang, Q., Zhou, Z., Wang, Y., Wang, X., Liu, Q., Liu, S., Yin, Z., & Wang, F. (2024). Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: A cross-sectional survey in China. Human Vaccines and Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2333098
Itzler, R., O’Brien, M. A., Yamabe, K., Abe, M., & Dhankhar, P. (2013). Cost-effectiveness of a pentavalent rotavirus vaccine in Japan. Journal of Medical Economics, 16(10), 1216–1227. https://doi.org/10.3111/13696998.2013.831869
Kementerian Kesehatan Republik Indonesia. (2017). Peraturan Menteri Kesehatan Nomor 12 Tahun 2017 tentang Penyelenggaraan Imunisasi. Diakses dari https://peraturan.bpk.go.id/Download/102930/Permenkes%20Nomor%2012%20Tahun%202017.pdf
Kementerian Kesehatan Republik Indonesia. (2022). Capaian Imunisasi Kejar di Luar Jawa-Bali Hanya 35 Persen. Sehat Negeriku – Biro Komunikasi dan Pelayanan Publik. Diakses dari https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20221203/1041910/propinsi-luar-jawa-bali-capaian-imunisasi-kejar-hanya-35/
Kementerian Kesehatan Republik Indonesia. (2025). Pekan Imunisasi Dunia 2025: Ayo Lengkapi Imunisasi untuk Generasi Sehat Menuju Indonesia Emas. Diakses dari https://kemkes.go.id/id/pekan-imunisasi-dunia-2025-ayo-lengkapi-imunisasi-untuk-generasi-sehat-menuju-indonesia-emas
Kumar, P., Mehra, R., Ray, A., Kumari, A., Singh, K., Hora, R., Kaur, A., Koshal, S. S., Quadri, S. F., Singh, S. K., Sultana, A., & Roy, A. D. (2025). Stakeholders Perspectives on the Introduction of an Additional Injectable Vaccine Under the Universal Immunization Programme in India. Vaccines, 13(3), 1–14. https://doi.org/10.3390/vaccines13030334
Janko, M. M., Joffe, J., Michael, D., Earl, L., Rosettie, K. L., Sparks, G. W., Albertson, S. B., Compton, K., Pedroza Velandia, P., Stafford, L., Zheng, P., Aravkin, A., Kyu, H. H., Murray, C. J. L., & Weaver, M. R. (2022). Cost-effectiveness of rotavirus vaccination in children under five years of age in 195 countries: A meta-regression analysis. Vaccine, 40(28), 3903–3917. https://doi.org/10.1016/j.vaccine.2022.05.042
Liu, B., Cao, B., Wang, C., Sun, T., Miao, Y., Zhang, S., Zhao, T., & Cui, F. (2023). Cost-minimization analysis of DTaP-IPV-Hib combination vaccine in China: A nationwide cross-sectional study. Journal of Medical Virology, 95(1). https://doi.org/10.1002/jmv.28358
Luangasanatip, N., Mahikul, W., Poovorawan, K., Cooper, B. S., Lubell, Y., White, L. J., Teerawattananon, Y., & Pan-Ngum, W. (2021). Cost-effectiveness and budget impact analyses for the prioritisation of the four available rotavirus vaccines in the national immunisation programme in Thailand. Vaccine, 39(9), 1402–1414. https://doi.org/10.1016/j.vaccine.2021.01.051
Min, S., Kwon, S. H., Lee, Y. W., Lee, J. M., Bae, E. J., & Lee, E. K. (2023). Estimating the Total Societal Cost of a Hexavalent Vaccine versus a Pentavalent Vaccine with Hepatitis B in South Korea. Vaccines, 11(5). https://doi.org/10.3390/vaccines11050984
Mukherjee, P., Akpo, E. I. H., Kuznetsova, A., Knuf, M., Silfverdal, S. A., Kosalaraksa, P., & Mihalyi, A. (2021). Hexavalent vaccines in infants: a systematic literature review and meta-analysis of the solicited local and systemic adverse reactions of two hexavalent vaccines. Expert Review of Vaccines, 20(3), 319–330. https://doi.org/10.1080/14760584.2021.1892493
Olivera, I., Grau, C., Dibarboure, H., Torres, J. P., Mieres, G., Lazarov, L., Alvarez, F. P., & Yescas, J. G. L. (2020). Valuing the cost of improving Chilean primary vaccination: A cost minimization analysis of a hexavalent vaccine. BMC Health Services Research, 20(1), 1–9. https://doi.org/10.1186/s12913-020-05115-7
Olivera, I., Pérez, C. G., Lazarov, L., Lopez, E., Oddo, C., & Dibarboure, H. (2023). Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Services Research, 23(1), 1–11. https://doi.org/10.1186/s12913-023-10038-0
Owusu, R., Mvundura, M., Nonvignon, J., Armah, G., Bawa, J., Antwi-Agyei, K. O., Amponsa-Achiano, K., Dadzie, F., Bonsu, G., Clark, A., Pecenka, C., & Debellut, F. (2023). Rotavirus vaccine product switch in Ghana: An assessment of service delivery costs, switching costs, and cost-effectiveness. PLOS Global Public Health, 3(8), 1–17. https://doi.org/10.1371/journal.pgph.0001328
Özen, M., Ünüvar, E., Yıldırım, A., Akman, H., Mevlitoğlu, S., & Pehlivan, T. (2024). A worldwide overview for hexavalent vaccines and a glimpse into Turkiye’s perspective. Human Vaccines and Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2345493
Ray, S., Pathak, S., & Kshtriya, P. (2023). Critical Analysis of Economic Evaluation of the Childhood Rotavirus Vaccination in Low and Lower-Middle-Income Countries: A Systematic Review. Value in Health Regional Issues, 38, 18–28. https://doi.org/10.1016/j.vhri.2023.06.003
Romero, M., Góngora, D. S., Caicedo, M. L., Benchabane, D., & Lopez, J. G. (2021). Cost-Minimization and Budget Impact Analysis of a Hexavalent Vaccine (Hexaxim®) in the Colombian Expanded Program on Immunization. Value in Health Regional Issues, 26, 150–159. https://doi.org/10.1016/j.vhri.2021.06.001
Seinfeld, J., Sobrevilla, A., Rosales, M. L., Ibañez, M., Munayco, C., & Ruiz, D. (2024). Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for infants in Peru: a cost-consequence analysis of vaccination coverage. BMC Health Services Research, 24(1), 1216. https://doi.org/10.1186/s12913-024-11684-8
Sharma, H., Parekh, S., Pujari, P., Shewale, S., Desai, S., Kawade, A., Lalwani, S., Ravi, M. D., Kamath, V., Mahopatra, J., Kulkarni, G., Tayade, D., Ramanan, P. V., Uttam, K. G., Rawal, L., Gawande, A., Kumar, N. R., Tiple, N., Vagha, J., … Gairola, S. (2024). A phase III randomized-controlled study of safety and immunogenicity of DTwP-HepB-IPV-Hib vaccine (HEXASIIL®) in infants. Npj Vaccines, 9(1). https://doi.org/10.1038/s41541-024-00828-w
Thompson DG, O’Brien S, Kennedy A, et al. A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment. Southampton (UK): NIHR Journals Library; 2018 Mar. (Programme Grants for Applied Research, No. 6.1.) Appendix 3, The CHEERS checklist. https://www.ncbi.nlm.nih.gov/books/NBK487590/
Wenger, C., Asare, E. O., Kwon, J., Li, X., Mwinjiwa, E., Chinkhumba, J., Jere, K. C., Hungerford, D., Cunliffe, N. A., Paltiel, A. D., & Pitzer, V. E. (2025). Cost-effectiveness analysis of alternative infant and neonatal rotavirus vaccination schedules in Malawi. PLOS Global Public Health, 5(4 April), 1–17. https://doi.org/10.1371/journal.pgph.0004341
World Health Organization. (2019). Immunization coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
Zhang, H., Lai, X., Patenaude, B. N., Jit, M., & Fang, H. (2023). Adding new childhood vaccines to China’s National Immunization Program: evidence, benefits, and priorities. The Lancet Public Health, 8(12), e1016–e1024. https://doi.org/10.1016/S2468-2667(23)00248-7.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Fadhila Aulia Dila, Raodiatul Jumiati, Fitri Fitri, Eka Abelian Putri Kelana, Sulistyaningsih Sulistyaningsih, Putri Listiani
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Health Technology Assessment in Midwifery agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Journal of Health Technology Assessment in Midwifery is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License..
