The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies

Abstract

National and global health policymakers require good information about the costs and benefits of their investments in measles and rubella immunization programs. Building on our review of the existing measles and rubella health economics literature, we develop inputs for use in regional and global models of the expected future benefits and costs of vaccination, treatment, surveillance, and other global coordination activities. Given diversity in the world and limited data, we characterize the costs for countries according to the 2013 World Bank income levels using 2013 U.S. dollars (2013$US). We estimate that routine immunization and supplemental immunization activities will cost governments and donors over 2013$US 2.3 billion per year for the foreseeable future, with high-income countries accounting for 55% of the costs, to vaccinate global birth cohorts of approximately 134 million surviving infants and to protect the global population of over 7 billion people. We find significantly higher costs and health consequences of measles or rubella disease than with vaccine use, with the expected disability-adjusted life year (DALY) loss for case of disease generally at least 100 times the loss per vaccine dose. To support estimates of the economic benefits of investments in measles and/or rubella elimination or control, we characterize the probabilities of various sequelae of measles and rubella infections and vaccine adverse events, the DALY inputs for health outcomes, and the associated treatment costs. Managing measles and rubella to achieve the existing and future regional measles and rubella goals and the objectives of the Global Vaccine Action Plan will require an ongoing commitment of financial resources that will prevent adverse health outcomes and save the associated treatment costs.

Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases

“…Table summarizes the estimated measles, rubella, and adverse outcomes associated with infections in early pregnancy aggregated by 2013 income level and the associated estimated DALYs and costs for treatment and vaccination for 2013. Table also shows estimated costs of $3 billion associated with measles and rubella immunization in 2013 using the estimated doses from the model, which leads to slightly higher estimated immunization costs than a prior $2.3 billion estimate due to changes in coverage estimates and the inclusion of ORI in the model (e.g., for the United States and the Netherlands). When combined, these results suggest potential savings of over $7 billion or $10 billion (if including home costs) per year if the world were to eradicate measles and rubella instead of continuing to pursue control.…”

“…The opportunity to update the model with improved information makes it a useful living tool, but it also implies that as information improves, some estimates will change. However, the overall conclusion that eradication would save billions of dollars per year in treatment costs and could save over a billion dollars per year associated with vaccination costs remains robust, and it reflects the reality that the expected costs associated with treating measles and rubella infections far exceed the expected costs associated with immunization …”

“…Consistent with prior models, we assume a higher R 0 for measles than for rubella in each modeled area . Similar to global poliovirus models and consistent with an approach of stratifying the economics of measles and rubella by World Bank income level, we use different ranges for R 0 values by the area income level (i.e., high, upper middle, lower middle, low) with ranges of area‐specific values for each income level summarized in Table .…”

“…We explore the behavior of the model in the context of available epidemiological data and the results of serological surveys that provide a snapshot of the dynamic population immunity at the time of data collection. For measles, we could potentially observe most of the cases (i.e., relatively few asymptomatic infections), while for rubella relatively more asymptomatic infections occur . For both measles and rubella, not all symptomatic infections get detected and/or reported, with almost no systematic reporting systems existing for CRS.…”

Clinical Trial of Measles and Rubella Combined Vaccine Produced by POLYVAC in Vietnam

“…Especially, Thompson and Odahowski [24] The global birth cohort is approximately 134 million, and 300 million doses of MR or MMR vaccines would be required. A stable supply at an affordable cost would increase vaccine coverage and contribute to measles and rubella eradication.…”