Costs of routine immunization and the introduction of new and underutilized vaccines in Ghana

Gargasson, Jean-Bernard Le; Nyonator, Frank; Adibo, Moses; Gessner, Bradford D.; Colombini, Anaïs

doi:10.1016/j.vaccine.2014.12.081

Cited by 42 publications

(54 citation statements)

References 11 publications

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“…Our analysis found an average economic cost per dose of US$19.98 and an average financial cost per dose of US$8.74. This is within the range of operational costs found in non-Gavi pilot projects [ 14 ], but is still significantly higher than the delivery costs of routine EPI vaccines [ 13 , 20 – 23 ]. By contrast, the financial cost per FIG to deliver a three-dose schedule in countries with national HPV vaccination programs was much lower: $10.23 in Rwanda and $7.58 in Bhutan with school-based campaign strategies [ 16 , 19 , 24 ].…”

Section: Discussionmentioning

confidence: 72%

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

et al. 2017

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From 2012 to 2016, Gavi, the Vaccine Alliance, provided support for countries to conduct small-scale demonstration projects for the introduction of the human papillomavirus vaccine, with the aim of determining which human papillomavirus vaccine delivery strategies might be effective and sustainable upon national scale-up. This study reports on the operational costs and cost determinants of different vaccination delivery strategies within these projects across twelve countries using a standardized micro-costing tool. The World Health Organization Cervical Cancer Prevention and Control Costing Tool was used to collect costing data, which were then aggregated and analyzed to assess the costs and cost determinants of vaccination. Across the one-year demonstration projects, the average economic and financial costs per dose amounted to US$19.98 (standard deviation ±12.5) and US$8.74 (standard deviation ±5.8), respectively. The greatest activities representing the greatest share of financial costs were social mobilization at approximately 30% (range, 6–67%) and service delivery at about 25% (range, 3–46%). Districts implemented varying combinations of school-based, facility-based, or outreach delivery strategies and experienced wide variation in vaccine coverage, drop-out rates, and service delivery costs, including transportation costs and per diems. Size of target population, number of students per school, and average length of time to reach an outreach post influenced cost per dose. Although the operational costs from demonstration projects are much higher than those of other routine vaccine immunization programs, findings from our analysis suggest that HPV vaccination operational costs will decrease substantially for national introduction. Vaccination costs may be decreased further by annual vaccination, high initial investment in social mobilization, or introducing/strengthening school health programs. Our analysis shows that drivers of cost are dependent on country and district characteristics. We therefore recommend that countries carry out detailed planning at the national and district levels to define a sustainable strategy for national HPV vaccine roll-out, in order to achieve the optimal balance between coverage and cost.

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Section: Discussionmentioning

confidence: 72%

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

et al. 2017

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“…The EPIC studies collected information on service volume, costs and other characteristics for 319 sites providing routine immunization services in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia during the 12month period January-December 2011 [22]. Data were collected through a series of country-level studies implemented during 2012-13 [25][26][27][28][29][30]. Sites were selected from a sampling frame consisting of public and NGO facilities providing routine immunization services, and data were collected using a standardized approach [31], to allow comparison and pooling of data across sites and settings.…”

Section: Data and Samplementioning

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

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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.

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“…The Expanded Program on Immunization Costing and Financing (EPIC) Project was designed to fill this knowledge gap, providing detailed data on routine immunization costs and financing in a large, representative sample of immunization sites in six countries (Benin, Ghana, Honduras, Moldova, Uganda, and Zambia) [ 7 ]. Information from these studies has already been used to improve information on unit costs [ 8 – 11 ], cost trends [ 12 , 13 ], and financing [ 14 , 15 ] within individual countries. We synthesized data from these country studies to create a unique pooled dataset of 316 sites to explore cross-country determinants of costs.…”

Section: Introductionmentioning

confidence: 99%

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

Menzies¹,

Suharlim²,

Geng³

et al. 2017

BMC Med

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BackgroundEvidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia.MethodsWe developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume.ResultsAcross countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely—on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0–32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product.ConclusionsWe identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0942-1) contains supplementary material, which is available to authorized users.

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Costs of routine immunization and the introduction of new and underutilized vaccines in Ghana

Cited by 42 publications

References 11 publications

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

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

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

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