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

Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J.; Brenzel, Logan; Resch, Stephen

doi:10.1186/s12916-017-0942-1

Cited by 16 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this analysis we draw on a unique data set of immunization service costs collected as part of the EPIC studies, funded by the Bill & Melinda Gates Foundation to fill the knowledge gap around immunization costs and financing. These data describe the costs and performance of a large, representative sample of immunization sites in Benin, Ghana, Honduras, Moldova Uganda and Zambia [22][23][24]. Using these data, we investigate different quantitative approaches for estimating the efficiency of immunization sites, to describe their relative performance and draw conclusions about their utility for efficiency evaluation within infant immunization programs, as well as provide summary estimates of efficiency at a country level and describe within-country variation in efficiency.…”

Section: Introductionmentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…The studies in Benin and Ghana found doses administered as significant determinants of cost; however, salary was not significantly associated [5] , [6] . The multi country study on determinants of immunization costs also found that higher health facility level was associated with higher costs probably because of differences in availability of staff and infrastructure [17] . Higher service volume was significantly associated with lower average cost while greater distance for vaccine collection was associated with higher facility cost.…”

Section: Discussionmentioning

confidence: 97%

“…Because of the measurement error in wastage rate, we dropped this variable from our regression model. The multi-country study on determinants of immunization cost also could not include vaccine wastage rate as an explanatory variable because of data limitations [17] .…”

Section: Discussionmentioning

confidence: 99%

“…It is expected that costs will increase with coverage as improving coverage will require more efforts for vaccinating hard-to-reach children. No firm conclusions were drawn on the reason of such negative relationship because of mismeasurement of reported coverage [17] .…”

Section: Discussionmentioning

confidence: 99%

“…The selection of these explanatory variables was motivated by an earlier study of immunization delivery cost determinants in six countries (Benin, Ghana, Honduras, Moldova, Uganda and Zambia), which reported relationships between many of these variables and total facility cost [17] . As India immunization costing study adopted the same costing methodology used in these six countries (Common Approach), we included similar explanatory variables in the model.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of cost of routine immunization programme in India

Chatterjee

Ghosh

Das

et al. 2018

Vaccine

Self Cite

View full text Add to dashboard Cite

The costs of delivering routine immunization services in India vary widely across facilities, districts and states. Understanding the factors influencing this cost variation could help predict future immunization costs and suggest approaches for improving the efficiency of service provision.We examined determinants of facility cost for immunization services based on a nationally representative sample of sub-centres and primary health centres (99 and 89 facilities, respectively) by regressing logged total facility costs, both including and excluding vaccine cost, against several explanatory variables. We used a multi-level regression model to account for the multi-stage sampling design, including state- and district-level random effects.We found that facility costs were significantly associated with total doses administered, type of facility, salary of the main vaccinator, number of immunization sessions, and the distance of the facility from the nearest cold chain point.Use of pentavalent vaccine by the state was an important determinant of total facility cost including vaccine cost. India is introducing several new vaccines including some supported by Gavi. Therefore, the government will have to ensure that additional resources will be made available after the support from Gavi ceases.

show abstract

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

Portnoy¹,

Vaughan²,

Clarke-Deelder

et al. 2020

PharmacoEconomics

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 16 publications

References 19 publications

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

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

Determinants of cost of routine immunization programme in India

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

Contact Info

Product

Resources

About