Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St, Baltimore, MD 21205, United States. Electronic address: .
Vaccine (Impact Factor: 3.62). 11/2012; 31(1). DOI: 10.1016/j.vaccine.2012.10.103
Source: PubMed

ABSTRACT Background:
Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.

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Available from: Sachiko Ozawa, Mar 18, 2015
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    • "Immunization is a proven and cost effective tool for control of infectious diseases [6] [7]. Vaccine preventable infections includes diphtheria, Haemophilus influenzae type B, hepatitis A, hepatitis B, human papilloma virus, influenza, measles, meningococcus, mumps, pertussis, pneumococcus, polio, rotavirus, rubella, smallpox, and tetanus. "
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    ABSTRACT: Background:Vaccines save more than 3 million lives and prevent 750,000 disabilities each year. Optimum immunization coverage will help in the fight against infectious diseases. This study was carried out to characterize current knowledge, attitudes, and practices regarding immunizations in a rural Ghanaian community and to help identify reasons for delayed vaccination and suboptimal vaccination rates. Methods:A cross-sectional study was conducted in July 2013 on 156 parents and caregivers of children aged between 1 month and 5 years old. Structured questionnaires were administered to elicit responses on knowledge, attitudes, and practices towards childhood immunization. Results: Almost all study participants knew about vaccination (98.7%). However, unsolicited awareness of the benefits of vaccination was poor, and there existed knowledge gaps about vaccine preventable diseases. Nonetheless, most study participants (94.8%) acknowledged every child’s right to vaccination. The most prominent factors that influence the decision to participate in vaccination include recommendation by a local nurse (13.2%) or other health worker (10.4%), or a supportive spouse (11.8%). Adherence to vaccination schedules were generally low, but parents with a primary educational level were approximately 6 times more likely to adhere to vaccination schedules for the routine expanded programme on immunization vaccines than were parents with a secondary level of education. Conclusion:There was an almost universal awareness of vaccination among study participants. But poor knowledge of the benefits of vaccination and of vaccine preventable diseases ought to be addressed through education in order to promote improved and timely vaccination coverage.
    08/2014; 2(2). DOI:10.14312/2053-1273.2014-2
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    • "Vaccines are the most cost-effective health intervention for the prevention of disease [1]. Since their invention, vaccines have been administered to billions of individuals with significant health and economic benefits, particularly to people in low-and middleincome countries [2] [3]. "
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    ABSTRACT: Financing for global health is a critical element of research and development. Innovations in new vaccines are critically dependent on research funding given the large sums required, however estimates of global research investments are lacking. We evaluate infectious disease research investments, focusing on immunology and vaccine research by UK research funding organisations. In 1997-2010, £2.6 billion were spent by public and philanthropic organisations, with £590 million allocated to immunology and vaccine research. Preclinical studies received the largest funding amount £505 million accounting for 85.6% of total investment. In terms of specific infection, "the big three" infections dominated funding: HIV received £127 million (21.5% of total), malaria received £59 million (10.0% of total) and tuberculosis received £36 million (6.0% of total). We excluded industry funding from our analysis, as open-access data were unavailable. A global investment surveillance system is needed to map and monitor funding and guide allocation of scarce resources.
    Vaccine 10/2013; 31(50). DOI:10.1016/j.vaccine.2013.10.048 · 3.62 Impact Factor
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    ABSTRACT: Global mortality in children younger than 5 years has fallen substantially in the past two decades from more than 12 million in 1990, to 6·9 million in 2011, but progress is inconsistent between countries. Pneumonia and diarrhoea are the two leading causes of death in this age group and have overlapping risk factors. Several interventions can effectively address these problems, but are not available to those in need. We systematically reviewed evidence showing the effectiveness of various potential preventive and therapeutic interventions against childhood diarrhoea and pneumonia, and relevant delivery strategies. We used the Lives Saved Tool model to assess the effect on mortality when these interventions are applied. We estimate that if implemented at present annual rates of increase in each of the 75 Countdown countries, these interventions and packages of care could save 54% of diarrhoea and 51% of pneumonia deaths by 2025 at a cost of US$3·8 billion. However, if coverage of these key evidence-based interventions were scaled up to at least 80%, and that for immunisations to at least 90%, 95% of diarrhoea and 67% of pneumonia deaths in children younger than 5 years could be eliminated by 2025 at a cost of $6·715 billion. New delivery platforms could promote equitable access and community platforms are important catalysts in this respect. Furthermore, several of these interventions could reduce morbidity and overall burden of disease, with possible benefits for developmental outcomes.
    The Lancet 04/2013; 381(9875). DOI:10.1016/S0140-6736(13)60648-0 · 45.22 Impact Factor
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