Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis

Abstract

Vaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication.

Inclusion of equity in economic analyses of public health policies: systematic review and future directions

“…The main type of intervention analysed (n=8) was vaccination programs for the prevention of a range of conditions, including rotavirus, 26,27 pneumonia, 28 human papillomavirus, 29,30 measles 31 and tuberculosis 32 . Three studies looked at fiscal policies, including an increase in tobacco taxes 33,34 and a subsidy and tax decrease for fresh fruit and vegetables 35 .…”

“…Seven studies were CUAs 30,34,36–40 and eight studies were CEAs 26–29,31–33,35 . Seven studies compared two or more interventions to current practice, 28,30,31,34–37 while the remainder compared a single intervention to current practice. Studies originated from a range of low, middle and high‐income countries 41 .…”

“…Studies originated from a range of low, middle and high‐income countries 41 . There were three interventions each from the United Kingdom, 36–38 India 26,27,32 and Ethiopia, 26,28,31 two from China 29,33 and New Zealand, 30,39 and one each from the Netherlands, 34 Australia 40 and France 35 …”

“…The most commonly used measure of SEP was household income or wealth quintiles, utilised in eight of the 15 studies 26–29,31–33,35 . Five studies used area level deprivation or disadvantage that took into account multiple factors such as employment, income, education and housing 30,36,38–40 .…”

“…Aims of the studies : For 14 of the 15 studies, 26–38,40 the main aims included the evaluation of the health outcomes across SEP groups. The remaining study did not explicitly mention an aim to analyse the health benefits by SEP groups 39 …”