Vaccines are most cost-effective in low-income groups and regions. – VoICE
Key Concept

Key Evidence: An analysis of the impact of rotavirus vaccine in 25 countries found that the rates of vaccination in all countries were highest and risk mortality lowest in the top two wealth quintile’s coverage. Countries differed in the relative inequities in these two underlying variables. Cost per DALYs averted in substantially greater in the higher quintiles. In all countries, the greatest potential vaccine benefit was in the poorest quintiles; however, reduced vaccination coverage lowered the projected vaccine benefit.

Rheingans, R., Atherly, D., and Anderson, J. 2012. Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness. Vaccine. 30(1).
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Key Evidence: In an analysis of the impact and cost-effectiveness of pneumococcal conjugate vaccines (PCV) in preventing disease and deaths in children under five years in 180 countries, the vaccination was most cost-effective in low income regions and Gavi-eligible countries. The average cost per disability adjusted life year (DALY) was $118 in Africa, $853 in Asia, and $16,000 in Europe. PCV introduction throughout Africa would account for nearly 70% of lives saved globally, but requires only 12% of the global investment.

From the VoICE Editors: The cost estimates were calculated in international dollars. 

Chen C, Liceras FC, Flasche S et al. 2019. Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis. Lancet Global Health. 7(1).
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Key Evidence: Children in the poorest 20% of households in Laos have a 4-5 times greater risk of dying from rotavirus than the richest 20%. Consequently, rotavirus vaccination was almost five times more cost-effective in the lowest income groups in the Central Region than in the richest households in the wealthier North region. Thus, rotavirus vaccination has a greater potential for health gains and greater cost-effectiveness among marginalized populations.

From the VoICE Editors: Note that these gains are dependent on improving vaccination coverage, access to health care and environmental health in these populations.

Rheingans R, Anderson JD, Bagamian KH, et al. 2018. Effects of geographic and economic heterogeneity on rotavirus diarrhea burden and vaccination impact and cost-effectiveness in the Lao People’s Democratic Republic. Vaccine. 36.
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Key Evidence: According to a cost-effectiveness study of rotavirus vaccination in Pakistan, the vaccine would be the most cost-effective in the poorer provinces of Sindh and Balochistan (that also have the highest rates of death from rotavirus)- with a cost per disability-adjust life year averted $155-$167 compared to almost $600 in the wealthier region of Islamabad. Within all regions, vaccination was the most cost-effective among the two poorest income groups (quintiles), and was almost 12 times more cost-effective in the poorest households in the most marginalized region than in the wealthiest households in the most advantaged region (cost/DALY averted of $76 vs. $897).

Rheingans R, Anderson JD, Bagamian KH et al. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).
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Key Evidence: A study looking at the impact of pneumococcal vaccine introduction and scaling up pneumonia treatment in Ethiopia found that 30-40% of all deaths averted by these interventions would be expected to occur in the poorest wealth quintile. The greatest resulting financial risk protection would also be concentrated among the bottom income quintile.

Johannsen, K.A, Memirie, S.T., Pecenka, C. et al 2015. Health gains and financial protection from pneumococcal vaccination and pneumonia treatment in Ethiopia: Results from an extended cost-effectiveness analysis. PLOS ONE. 10(12).
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Key Evidence: A study of measles vaccine in Bangladesh found that children from the poorest quintile were more than twice as likely to die as those from the least quintile in the absence of measles vaccination. The difference in mortality between unvaccinated and vaccinated was statistically significant (p<0.10) and robust across alternative measures of socioeconomic status.

Bishai, D., Koenig, M., and Khan, M.A. 2003. Measles vaccination improves the equity of health outcomes: evidence from Bangladesh. Health Economics. 12(5).
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