Cost analysis of routine immunisation in Zambia

Schütte, Carl; Chansa, Collins; Marinda, Edmore; Guthrie, Teresa; Banda, Stanley; Nombewu, Zipozihle; Motlogelwa, Katlego; Lervik, Marita; Brenzel, Logan; Kinghorn, Anthony

doi:10.1016/j.vaccine.2014.12.040

Cited by 29 publications

(50 citation statements)

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“…Three sites were excluded due to unresolved inconsistencies. Data cleaning and standardization resulted in minor differences with earlier studies’ country-level results [ 8 – 11 ]. Datasets and related materials are available at www.immunizationeconomics.org and archived on Dataverse [ 19 ].…”

Section: Methodsmentioning

confidence: 90%

“…The Expanded Program on Immunization Costing and Financing (EPIC) Project was designed to fill this knowledge gap, providing detailed data on routine immunization costs and financing in a large, representative sample of immunization sites in six countries (Benin, Ghana, Honduras, Moldova, Uganda, and Zambia) [ 7 ]. Information from these studies has already been used to improve information on unit costs [ 8 – 11 ], cost trends [ 12 , 13 ], and financing [ 14 , 15 ] within individual countries. We synthesized data from these country studies to create a unique pooled dataset of 316 sites to explore cross-country determinants of costs.…”

Section: Introductionmentioning

confidence: 99%

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The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

Menzies¹,

Suharlim²,

Geng³

et al. 2017

BMC Med

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BackgroundEvidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia.MethodsWe developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume.ResultsAcross countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely—on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0–32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product.ConclusionsWe identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0942-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

Menzies¹,

Suharlim²,

Geng³

et al. 2017

BMC Med

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“…The EPIC studies collected information on service volume, costs and other characteristics for 319 sites providing routine immunization services in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia during the 12month period January-December 2011 [22]. Data were collected through a series of country-level studies implemented during 2012-13 [25][26][27][28][29][30]. Sites were selected from a sampling frame consisting of public and NGO facilities providing routine immunization services, and data were collected using a standardized approach [31], to allow comparison and pooling of data across sites and settings.…”

Section: Data and Samplementioning

confidence: 99%

The efficiency of routine infant immunization services in six countries: a comparison of methods

Menzies

Suharlim²,

Resch³

et al. 2020

Health Econ Rev

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Background: Few studies have systematically examined the efficiency of routine infant immunization services. Using a representative sample of infant immunization sites in Benin, Ghana, Honduras, Moldova, Uganda and Zambia (316 total), we estimated average efficiency levels and variation in efficiency within each country, and investigated the properties of published efficiency estimation techniques. Methods: Using a dataset describing 316 immunization sites we estimated site-level efficiency using Data Envelopment Analysis (DEA), Stochastic Frontier Analysis (SFA), and a published ensemble method combining these two approaches. For these three methods we operationalized efficiency using the Sheppard input efficiency measure, which is bounded in (0, 1), with higher values indicating greater efficiency. We also compared these methods to a simple regression approach, which used residuals from a conventional production function as a simplified efficiency index. Inputs were site-level service delivery costs (excluding vaccines) and outputs were total clients receiving DTP3. We analyzed each country separately, and conducted sensitivity analysis for different input/ output combinations. Results: Using DEA, average input efficiency ranged from 0.40 in Ghana and Moldova to 0.58 in Benin. Using SFA, average input efficiency ranged from 0.43 in Ghana to 0.69 in Moldova. Within each country scores varied widely, with standard deviation of 0.18-0.23 for DEA and 0.10-0.20 for SFA. Input efficiency estimates generated using SFA were systematically higher than for DEA, and the rank correlation between scores ranged between 0.56-0.79. Average input efficiency from the ensemble estimator ranged between 0.41-0.61 across countries, and was highly correlated with the simplified efficiency index (rank correlation 0.81-0.92) as well as the DEA and SFA estimates. Conclusions: Results imply costs could be 30-60% lower for fully efficient sites. Such efficiency gains are unlikely to be achievable in practicesome of the apparent inefficiency may reflect measurement errors, or unmodifiable differences in the operating environment. However, adapted to work with routine reporting data and simplified methods, efficiency analysis could triage low performing sites for greater management attention, or identify more efficient sites as models for other facilities.

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“…In addition, Geng et al (2017) and Schütte et al (2015) have demonstrated that program costs do not 29 scale linearly at a facility level and Ahanhanzo et al (2015) demonstrated that the size of a clinic is an 30 important cost driver. In this paper, we examine whether programmatic costs for supplementary 31 immunization activities (SIAs) demonstrate efficiencies of scale.…”

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confidence: 99%

Evidence of the Cost-Efficiency of Scale as seen in Polio Vaccination and Surveillance Costs

Hagedorn

Mercer

Chabot-Couture

2019

Preprint

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9 This analysis examined how polio program costs vary with scale for vaccination and disease surveillance, 10 based on historical budget data published by the Global Polio Eradication Initiative (GPEI) from 2005 to 11 2018. We applied a linear mixed effects regression model in order to understand the cost structure of 12 the historical GPEI budgets, with the goal that lessons learned from polio may be extended to other 13 global disease elimination programs. Our findings demonstrate that there are economies of scale for 14 vaccine delivery operations and for disease surveillance, which means that larger programs can leverage 15 fixed costs and achieve better cost-efficiency as they scale. This finding should enable decision makers 16 to create more reliable budgets, which support fundraising and optimal resource allocation. They also 17 provide insight into how cost effectiveness changes as programs scale up during progressive disease 18 control and elimination, as well as what level of resources are needed to sustain a program that is 19 scaling back post-eradication and through to certification. 20

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Cost analysis of routine immunisation in Zambia

Cited by 29 publications

References 11 publications

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

The efficiency of routine infant immunization services in six countries: a comparison of methods

Evidence of the Cost-Efficiency of Scale as seen in Polio Vaccination and Surveillance Costs

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