Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries

Abstract

BackgroundIn recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness of interventions to improve immunization coverage, despite this being a major focus of policy attention. Without this information, countries and international stakeholders have little objective evidence on the efficiency of competing interventions for improving coverage.MethodsWe conducted a systematic literature review on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries, including both published and unpublished reports. We evaluated the quality of included studies and extracted data on costs and incremental coverage. Where possible, we calculated incremental cost-effectiveness ratios (ICERs) to describe the efficiency of each intervention in increasing coverage.ResultsA total of 14 out of 41 full text articles reviewed met criteria for inclusion in the final review. Interventions for increasing immunization coverage included demand generation, modified delivery approaches, cash transfer programs, health systems strengthening, and novel technology usage. We observed substantial heterogeneity in costing methods and incompleteness of cost and coverage reporting. Most studies reported increases in coverage following the interventions, with coverage increasing by an average of 23 percentage points post-intervention across studies. ICERs ranged from $0.66 to $161.95 per child vaccinated in 2017 USD. We did not conduct a meta-analysis given the small number of estimates and variety of interventions included.ConclusionsThere is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-4468-4) contains supplementary material, which is available to authorized users.

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

“…First, the studies we included in the analysis were heterogeneous in terms of the scope of costing, site selection, data collection methods, and the level of detail with which results were reported. This heterogeneity in costing study methods and reporting has been observed by prior reviews [51][52][53][54][55]. We attempted to deal with this by adopting an analytic strategy that allowed for differences in the cost categories and types of costs (i.e., financial vs. economic) reported.…”

Correlation between polio immunization coverage and overall morbidity and mortality for COVID-19: an epidemiological study

“…In addition, many other logistic deficiencies were reported including healthcare worker-related factors, the fragmentation of health information system, bad data management, and targets’ overreliance (Harrison et al 2020 ). Akin to that are the problems in the costs and cost-effectiveness of the immunization coverage in low- and middle-income countries (Munk et al 2019 ).…”

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

“…However, this result should not be interpreted causally. Given the design of our study, we cannot conclude whether increasing facility-level service delivery volume would lead to a decrease in costs; the cost of increasing coverage will depend on the intervention used to do so [43] .…”