WHO-led consensus statement on vaccine delivery costing: process, methods, and findings

Abstract

Background Differences in definitions and methodological approaches have hindered comparison and synthesis of economic evaluation results across multiple health domains, including immunization. At the request of the World Health Organization’s (WHO) Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC), WHO convened an ad hoc Vaccine Delivery Costing Working Group, comprising experts from eight organizations working in immunization costing, to address a lack of standardization and gaps in definitions and methodological guidance. The aim of the Working Group was to develop a consensus statement harmonizing terminology and principles and to formulate recommendations for vaccine delivery costing for decision making. This paper discusses the process, findings of the review, and recommendations in the Consensus Statement. Methods The Working Group conducted several interviews, teleconferences, and one in-person meeting to identify groups working in vaccine delivery costing as well as existing guidance documents and costing tools, focusing on those for low- and middle-income country settings. They then reviewed the costing aims, perspectives, terms, methods, and principles in these documents. Consensus statement principles were drafted to align with the Global Health Cost Consortium costing guide as an agreed normative reference, and consensus definitions were drafted to reflect the predominant view across the documents reviewed. Results The Working Group identified four major workstreams on vaccine delivery costing as well as nine guidance documents and eleven costing tools for immunization costing. They found that some terms and principles were commonly defined while others were specific to individual workstreams. Based on these findings and extensive consultation, recommendations to harmonize differences in terminology and principles were made. Conclusions Use of standardized principles and definitions outlined in the Consensus Statement within the immunization delivery costing community of practice can facilitate interpretation of economic evidence by global, regional, and national decision makers. Improving methodological alignment and clarity in program costing of health services such as immunization is important to support evidence-based policies and optimal resource allocation. On the other hand, this review and Consensus Statement development process revealed the limitations of our ability to harmonize given that study designs will vary depending upon the policy question that is being addressed and the country context.

Cost of introducing and delivering RTS,S/AS01 malaria vaccine within the malaria vaccine implementation program

“…The study employed an activity-based costing approach, where all activities associated with the introduction and delivery of the malaria vaccine were identified and costed individually. All activities were grouped into key categories of the vaccination program, including vaccine procurement, planning and coordination, training, communication, sensitization, social mobilization, service delivery, supervision, and monitoring of vaccine delivery [8] , [9] , [10] . Within each category, the levels and types of sub-activities vary by country, based on the need and the immunization program.…”

“…Introduction costs are considered capital costs and are discounted (only for economic cost). Recurrent costs consist of the value of resources used within one year and include operational costs of the program, such as the value of vaccines and immunization supplies, vaccine distribution, service delivery, monitoring and evaluation, and supervision [ 10 ].…”

Costs of seasonal influenza vaccination in South Africa

“…Due to the existence of the South African programme, start‐up costs were not included in this analysis. Financial costs are defined as the monetary outlays required to deliver the immunisation programme, while economic costs include, in addition to financial cost, the opportunity costs of using existing resources in the course of delivering the programme 20,24 . For example, financial costs would include the money spent to procure doses of vaccines, while economic costs would additionally include time spent on the vaccine programme by existing staff.…”

“…South Africa has used this mechanism to good effect in estimating the disease and economic burden of influenza as well as the cost‐effectiveness of the influenza vaccination programme 2,3,18 . An assessment of programme delivery and vaccine procurement costs would be useful to identify opportunities for improved efficiency, as well as to plan for potential expansion of the seasonal influenza vaccination programme 19,20 . Furthermore, although a decline in confirmed influenza cases during the COVID‐19 pandemic has been reported globally (including in South Africa) due to public health measures, this may result in future compensatory increases in influenza infections 21 .…”

“… 2 , 3 , 18 An assessment of programme delivery and vaccine procurement costs would be useful to identify opportunities for improved efficiency, as well as to plan for potential expansion of the seasonal influenza vaccination programme. 19 , 20 Furthermore, although a decline in confirmed influenza cases during the COVID‐19 pandemic has been reported globally (including in South Africa) due to public health measures, this may result in future compensatory increases in influenza infections. 21 This makes it even more important to understand the costs of the influenza vaccination programme to ensure effective planning and preparedness for a potential influenza epidemic.…”