The Net Economic Benefit of a Vaccine Coverage Level Increase for a Full Childhood Routine Immunization Schedule in Gavi-eligible Countries Open Access

Thomas, Mark (2016)

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Background: Gavi is assessing what resources would be required to achieve its stated strategic objective of a broad coverage level increase. While there is a large volume of literature on the cost-effectiveness of vaccines, little research has been done by looking at the immunization schedule holistically. Additionally, vaccination scenarios are almost always compared to those of no vaccination, which is less relevant in today's Gavi-eligible countries where scenarios should be separated by incremental changes in coverage level. The objective of this study is to quantify the net economic benefit of an increase in coverage level, across the full spectrum of routine childhood immunization, for archetypal Gavi-eligible countries from the decision making perspective of country health officials.

Methods: We constructed a decision tree model that incorporated cumulative incidence of vaccine-preventable disease, vaccine effectiveness, indirect effects of vaccination, distributions of possible outcomes for each disease and treatment costs. Data was aggregated from previous research completed in Gavi-eligible countries.

Results: The cost of a coverage level increase from 85% to 89% in an average Gavi-eligible country is $1.21 per child in the cohort. The number of cases of vaccine-preventable disease (VPD) decreased from 0.1108 cases per child in the low coverage scenario to 0.1056 cases in the high coverage scenario, for a cost per case avoided of $233. Through a series of sensitivity analyses, the cost of the vaccines strongly dominated the result and other variables--including cumulative incidence of disease, vaccine effectiveness, and the magnitude of indirect effects--did not substantively alter the result.

Conclusion: The cost to raise coverage levels, even with a narrow perspective on the benefits of vaccination, is quite low. Vaccine cost is the largest contributor to this result, which suggests that the net economic benefit will improve over time as vaccine cost goes down. This analysis, particularly the framework of looking at the full immunization schedule, can be used going forward by countries to make better decisions about health resource allocation.

Table of Contents

Abstract. 1

Introduction. 3

Data and Methods. .4

Framing. 4

Costs. 5

Model Overview. 7

Results. 10

Sensitivity analyses. 10

Discussion. 13

Limitations. 15

Conclusion. 15

References. 16

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