Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

Abstract

Background To plan for the financial sustainability of immunization programs and make informed decisions to improve immunization coverage and equity, decision-makers need to know how much these programs cost beyond the cost of the vaccine. Non-vaccine delivery cost estimates can significantly influence the cost-effectiveness estimates used to allocate resources at the country level. However, many low- and middle-income countries (LMICs) do not have immunization delivery unit cost estimates available, or have estimates that are uncertain, unreliable, or old. We undertook a Bayesian evidence synthesis to generate country-level estimates of immunization delivery unit costs for LMICs. Methods From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. A Bayesian meta-regression model was used to regress delivery cost per dose estimates, stratified by cost category, against a set of predictor variables including country-level [gross domestic product per capita, reported diphtheria-tetanus-pertussis third dose coverage (DTP3), population, and number of doses in the routine vaccination schedule] and study-level (study year, single antigen or programmatic cost per dose, and financial or economic cost) predictors. The fitted prediction model was used to generate standardized estimates of the routine immunization delivery cost per dose for each LMIC for 2009–2018. Alternative regression models were specified in sensitivity analyses. Results We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64–4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26–1.70) for labor, $0.26 ($0.08–0.67) for supply chain, $0.22 ($0.06–0.57) for capital, and $0.65 ($0.20–1.66) for other service delivery costs. Conclusions Accurate immunization delivery costs are necessary for assessing the cost-effectiveness and strategic planning needs of immunization programs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.

Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania

“…If we included vaccine injection supplies, for increased comparability with the other studies, the estimated unit cost would be $1.83. Our estimate is close to the modelled estimate of $2.23 per dose (95% CI: $0.80–$5.07) for Tanzania in 2018, from a recent study that used available cost evidence to generate modelled estimates of unit costs for country-years where empirical evidence was not available [39] .…”

COVID-19 Vaccination Scenarios: A Cost-Effectiveness Analysis for Turkey

“…Thus, anticipating a continued uptake of COVID-19 vaccines, health technology assessment (HTA) bodies should already be conducted integrated analyses of allocative efficiency, affordability, and sustainability. Therefore, the accurate estimation of COVID-19 vaccination program costs, savings on health-care costs, potential broader impacts, and health impact assessments are needed in the context of HTA cost-effectiveness analyses and the strategic planning of allocating potentially scarce stocks of vaccines [ 16 ]. Additionally, when aiming for a fair distribution of vaccines with affordable pricing, individual countries should develop country-specific immunization programs and guidelines for its citizens while relying on solid data, preferably originating both from the countries themselves as well as from integrated global databases [ 17 ].…”

COVID-19 vaccination in Sindh Province, Pakistan: a modelling study of health impact and cost-effectiveness

“…Under base case assumptions, a single year of vaccination would be cost saving if the vaccine was priced at below USD 3 a dose. This assumes that vaccination can be delivered at USD 1 a dose, in line with incremental economic cost estimates from the EPIC vaccine delivery costs catalogue, which range between USD 0.48-1.38 for new vaccines (45). A vaccination campaign extended to 5 years or 10 years would no longer be cost saving, but would still have an ICER well below USD 300 per DALY averted.…”