Abstract:BackgroundUse of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers.ObjectivesTo review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization… Show more
“…With increasing interest in controlling cholera through vaccination, literature estimating the cost of Shanchol™, a low-cost oral cholera vaccine, is growing [ 21 – 24 ]. A limited number of review papers has also been published, reporting cholera vaccination costs in various settings [ 10 , 14 ]. Some of these studies reported cost estimates disaggregated by inputs [ 22 , 24 ], while others reported costs by activities [ 21 , 23 ].…”
Section: Discussionmentioning
confidence: 99%
“…High vaccine delivery costs may discourage its use in resource-limited settings. However, evidence on Shanchol delivery costs is questionable due to inconsistent collection and reporting of cost data [ 14 ]. This study aims to provide a detailed analysis of Shanchol delivery cost focusing on the case study of a reactive vaccination campaign in Lake Chilwa, Malawi.…”
BackgroundCholera is a diarrheal disease that produces rapid dehydration. The infection is a significant cause of mortality and morbidity. Oral cholera vaccine (OCV) has been propagated for the prevention of cholera. Evidence on OCV delivery cost is insufficient in the African context. This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi.MethodsThe vaccination campaign was implemented in two rounds in February and March 2016. Structured questionnaires were used to collect costs incurred for each vaccination related activity, including vaccine procurement and shipment, training, microplanning, sensitization, social mobilization and vaccination rounds. Costs collected, including financial and economic costs were analyzed using Choltool, a standardized cholera cost calculator.ResultsIn total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480275 while the economic cost was US$588637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97.ConclusionThis study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partners’ personnel may represent a substantial share of campaign’s costs, affecting unit and vaccine delivery costs.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2885-8) contains supplementary material, which is available to authorized users.
“…With increasing interest in controlling cholera through vaccination, literature estimating the cost of Shanchol™, a low-cost oral cholera vaccine, is growing [ 21 – 24 ]. A limited number of review papers has also been published, reporting cholera vaccination costs in various settings [ 10 , 14 ]. Some of these studies reported cost estimates disaggregated by inputs [ 22 , 24 ], while others reported costs by activities [ 21 , 23 ].…”
Section: Discussionmentioning
confidence: 99%
“…High vaccine delivery costs may discourage its use in resource-limited settings. However, evidence on Shanchol delivery costs is questionable due to inconsistent collection and reporting of cost data [ 14 ]. This study aims to provide a detailed analysis of Shanchol delivery cost focusing on the case study of a reactive vaccination campaign in Lake Chilwa, Malawi.…”
BackgroundCholera is a diarrheal disease that produces rapid dehydration. The infection is a significant cause of mortality and morbidity. Oral cholera vaccine (OCV) has been propagated for the prevention of cholera. Evidence on OCV delivery cost is insufficient in the African context. This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi.MethodsThe vaccination campaign was implemented in two rounds in February and March 2016. Structured questionnaires were used to collect costs incurred for each vaccination related activity, including vaccine procurement and shipment, training, microplanning, sensitization, social mobilization and vaccination rounds. Costs collected, including financial and economic costs were analyzed using Choltool, a standardized cholera cost calculator.ResultsIn total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480275 while the economic cost was US$588637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97.ConclusionThis study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partners’ personnel may represent a substantial share of campaign’s costs, affecting unit and vaccine delivery costs.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2885-8) contains supplementary material, which is available to authorized users.
“…Past systematic reviews on immunization delivery costs (IDCs) have consolidated only a portion of the costing evidence. They focused on either (1) a subset of vaccines, (2) a subset of economic evaluations (e.g., only cost-effectiveness or cost-benefit studies), or (3) only the incremental costs of new vaccine introduction (NUVI) [2], [1], [3], [4].Definition of Immunization Delivery Costs (IDC).We define immunization delivery costs (IDCs) (also referred to as operational costs) as the costs associated with delivering immunizations to target populations, exclusive of vaccine costs. Delivery costs may include any or all of the following recurrent and capital cost items: (1) paid human resources, (2) volunteer human resources, (3) per diem and travel allowances, (4) cold chain equipment and their overheads (e.g.…”
Introduction
Information on immunization delivery costs (IDCs) is essential for better planning and budgeting for the sustainability and performance of national programs. However, delivery cost evidence is fragmented and of variable quality, making it difficult for policymakers, planners, and other stakeholders to understand and use. This study aimed to consolidate and summarize the evidence on delivery costs, answering the question: What are the unit costs of vaccine delivery across low- and middle-income countries (LMICs) and through a variety of delivery strategies?
Methods
We conducted a systematic review of over 15,000 published and unpublished resources from 2005 to 2018 that included IDCs in LMICs. We quality-rated and extracted data from 61 resources that contained 410 immunization delivery unit costs (e.g., cost per dose, cost per fully immunized child). We converted cost findings to a common year (2016) and currency (U.S. dollars) to ensure comparability across studies and settings. We performed a descriptive and gap analysis and developed immunization delivery cost ranges using comparable unit costs for single vaccines and schedules of vaccines.
Results
The majority of IDC evidence comes from low-income countries and Sub-Saharan Africa. Most unit costs are presented as cost per dose and represent health facility-based delivery.
Discussion
The cost ranges may be higher than current estimates used in many LMICs for budgeting: $0.16–$2.54 incremental cost per dose (including economic, financial, and fiscal costs) for single, newly introduced vaccines, and $0.75–$9.45 full cost per dose (economic costs) for schedules of four to eight vaccines delivered to children under one.
Conclusions
Despite increased attention on improving coverage and strengthening immunization delivery, evidence on the cost of delivery is nascent but growing. The cost ranges can inform planning and policymaking, but should be used with caution given their width and the few unit costs used in their development.
“…[ 18 ] The price of a double dose of this vaccine is currently around US$3.7, [ 8 ] with vaccine delivery costs ranging from US$1.14 (I$4.08) to US$3.05 (I$14.39) per fully immunized person in 2014 dollars. [ 19 ] However, evidence to support its widespread use in prevention of cholera is limited. Particularly, additional quality data on the burden of cholera, costs-of-illness, delivery costs and cost-effectiveness of vaccines are needed to support evidence-based decisions regarding the use of OCV in the prevention of cholera in sub-Saharan countries.…”
Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients’ households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.
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