Introduction
Information on immunization delivery costs (IDCs) is essential for better planning and budgeting for the sustainability and performance of national programs. However, delivery cost evidence is fragmented and of variable quality, making it difficult for policymakers, planners, and other stakeholders to understand and use. This study aimed to consolidate and summarize the evidence on delivery costs, answering the question: What are the unit costs of vaccine delivery across low- and middle-income countries (LMICs) and through a variety of delivery strategies?
Methods
We conducted a systematic review of over 15,000 published and unpublished resources from 2005 to 2018 that included IDCs in LMICs. We quality-rated and extracted data from 61 resources that contained 410 immunization delivery unit costs (e.g., cost per dose, cost per fully immunized child). We converted cost findings to a common year (2016) and currency (U.S. dollars) to ensure comparability across studies and settings. We performed a descriptive and gap analysis and developed immunization delivery cost ranges using comparable unit costs for single vaccines and schedules of vaccines.
Results
The majority of IDC evidence comes from low-income countries and Sub-Saharan Africa. Most unit costs are presented as cost per dose and represent health facility-based delivery.
Discussion
The cost ranges may be higher than current estimates used in many LMICs for budgeting: $0.16–$2.54 incremental cost per dose (including economic, financial, and fiscal costs) for single, newly introduced vaccines, and $0.75–$9.45 full cost per dose (economic costs) for schedules of four to eight vaccines delivered to children under one.
Conclusions
Despite increased attention on improving coverage and strengthening immunization delivery, evidence on the cost of delivery is nascent but growing. The cost ranges can inform planning and policymaking, but should be used with caution given their width and the few unit costs used in their development.
Highlights
Poor practices and reporting oversights limit the understanding and use of immunization cost data.
Our review identified reporting problems on the vaccines costed, types of costs, and data analysis.
Our checklist offers a standard of practice for reporting on immunization costing studies.
Reporting that adheres to this checklist will increase the interpretability and use of evidence.
Expanding effective coverage in Vietnam will require better use of available resources and placing higher priority on primary care. The way providers are currently paid does not give priority to primary care and does not reflect the costs of delivering services. This paper aims to estimate the unit costs of primary care visits at commune health stations (CHS) in selected areas in Vietnam. Seventy-six CHS from two provinces in northern Vietnam were studied. Costs were calculated from the perspective of the CHS using the top-down costing using the step-down cost accounting technique in order to estimate the full cost of delivering services. On average, the cost of one outpatient visit in mountainous, rural and urban CHSs was VND 49,521 (US$2.40), VND 41,375 (US$2.01) and VND 39,794 (US$1.93), respectively. Personnel costs accounted for the highest share of total costs followed by medicines. The share of operating costs was minimal. On average, CHSs recover 18.9% of their total cost for an outpatient visit from social insurance payments or fees that can be charged patients. The results provide valuable information for policy-makers as they revise the provider payment methods to better reflect the costs of services and give greater priority to primary care.
Highlights:
Delivery costs represent 33% of total immunization program costs in Tanzania.
Costs are higher for outreach than for facility-based delivery.
We used calibration methods to estimate unit and total costs.
This work will inform domestic resource advocacy and planning.
Facilitating the 6-step evidence to policy and practice process led to increased recognition by national-and subnational-level stakeholders of the importance of generating and using cost evidence in all 3 countries. However, this did not necessarily translate to actual use. n Six lessons learned can help future researchers improve the use of immunization cost evidence in country planning and budgeting processes.
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