The costs of delivering vaccines in low- and middle-income countries: Findings from a systematic review

Abstract

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 Methods We conducted a systematic review of over 15,000 published and unpublished resources from 2005 to 2018 that included IDCs in LMICs.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.

Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania

“…However, this did not translate into a significant difference in costs between rural and urban areas overall, likely because outreach-based delivery made up only a small portion of delivery in the sampled facilities (approximately 5%) and was only implemented in 21 out of the 51 facilities in our sample. This finding contributes to a growing literature on the question of how costs vary by service delivery strategy [44] , [45] .…”

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

“…We relied on a publicly available database describing immunization delivery costs in LMIC settings-the Immunization Delivery Cost Catalogue (IDCC) maintained by the Immunization Costing Action Network (ICAN) [9,11]. The IDCC is an online web catalog and downloadable Excel spreadsheet of immunization delivery cost evidence in LMIC settings, which describes the results of a systematic review of published and grey literature available between January 2005 and March 2019.…”

“…The objective of this study was to produce standardized country-level estimates of immunization delivery unit costs for all countries meeting the World Bank's LMIC classification (136 total) [10], via an evidence synthesis of available data on immunization delivery costs [9,11]. Using these data, we fit a Bayesian meta-regression model for routine childhood (i.e., under-five) vaccination program delivery unit costs.…”

“…Despite the multiple uses of accurate cost estimates, many LMICs have not conducted an empirical study of immunization services costs, or rely on estimates that are highly uncertain, unreliable, or old. While this evidence gap has been narrowed by recent efforts to improve the production and collation of immunization costing data—with 37 LMICs represented in available costing studies [ 7 – 9 ]—these efforts would need to be expanded substantially in order to supply all countries with up-to-date and high-quality cost estimates.…”

Influenza in the school-aged population in Mexico: burden of disease and cost-effectiveness of vaccination in children

“…We also acknowledge the importance of careful consideration of the method used for performing an economic analysis. While the assumptions used in our study differ from others recently published [51,52], we believe that the assumptions behind our estimates are solid and our bias is somewhat controlled as we cite official public pricing. Finally, we realize that the use of estimated incidence rates reported by Centers for Disease Control and Prevention (United States of America) for indirect standardisation of incidence rates for Mexico may not be ideal; however, we thought this was necessary because the SISVEFLU database likely underestimates the number of cases from primary care clinics, lacks the necessary population representation and most type B influenza cases reported in the database do not have lineage analysis (Additional file 1: Supplement 1; Text S1.2).…”